1
|
Tusell M, Steinhardt LC, Gutman J, Schneider ZD, Bhamani B, Shah MP, Martí Coma-Cros E, Gimnig JE, Allen KC, Akl EA, Lindblade KA. Development of Systematic Reviews to Inform WHO's Recommendations for Elimination and Prevention of Re-Establishment of Malaria: Methodology. Am J Trop Med Hyg 2024; 110:11-16. [PMID: 38118164 PMCID: PMC10993789 DOI: 10.4269/ajtmh.22-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 10/09/2023] [Indexed: 12/22/2023] Open
Abstract
The basis for an evidence-based recommendation is a well-conducted systematic review that synthesizes the primary literature relevant to the policy or program question of interest. In 2020, the WHO commissioned 10 systematic reviews of potential interventions in elimination or post-elimination settings to summarize their impact on malaria transmission. This paper describes the general methods used to conduct this series of systematic reviews and notes where individual reviews diverged from the common methodology. The paper also presents lessons learned from conducting the systematic reviews to make similar future efforts more efficient, standardized, and streamlined.
Collapse
Affiliation(s)
- Maria Tusell
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Laura C. Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zachary D. Schneider
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beena Bhamani
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Monica P. Shah
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elisabet Martí Coma-Cros
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - John E. Gimnig
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koya C. Allen
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Kim A. Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Higgins JPT, Morgan RL, Rooney AA, Taylor KW, Thayer KA, Silva RA, Lemeris C, Akl EA, Bateson TF, Berkman ND, Glenn BS, Hróbjartsson A, LaKind JS, McAleenan A, Meerpohl JJ, Nachman RM, Obbagy JE, O'Connor A, Radke EG, Savović J, Schünemann HJ, Shea B, Tilling K, Verbeek J, Viswanathan M, Sterne JAC. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ Int 2024; 186:108602. [PMID: 38555664 DOI: 10.1016/j.envint.2024.108602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/26/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Observational epidemiologic studies provide critical data for the evaluation of the potential effects of environmental, occupational and behavioural exposures on human health. Systematic reviews of these studies play a key role in informing policy and practice. Systematic reviews should incorporate assessments of the risk of bias in results of the included studies. OBJECTIVE To develop a new tool, Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E) to assess risk of bias in estimates from cohort studies of the causal effect of an exposure on an outcome. METHODS AND RESULTS ROBINS-E was developed by a large group of researchers from diverse research and public health disciplines through a series of working groups, in-person meetings and pilot testing phases. The tool aims to assess the risk of bias in a specific result (exposure effect estimate) from an individual observational study that examines the effect of an exposure on an outcome. A series of preliminary considerations informs the core ROBINS-E assessment, including details of the result being assessed and the causal effect being estimated. The assessment addresses bias within seven domains, through a series of 'signalling questions'. Domain-level judgements about risk of bias are derived from the answers to these questions, then combined to produce an overall risk of bias judgement for the result, together with judgements about the direction of bias. CONCLUSION ROBINS-E provides a standardized framework for examining potential biases in results from cohort studies. Future work will produce variants of the tool for other epidemiologic study designs (e.g. case-control studies). We believe that ROBINS-E represents an important development in the integration of exposure assessment, evidence synthesis and causal inference.
Collapse
Affiliation(s)
- Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Evidence Synthesis Group, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew A Rooney
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kyla W Taylor
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kristina A Thayer
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | | | | | - Elie A Akl
- Faculty of Medicine, American University of Beirut, Riad El-Solh, Lebanon
| | - Thomas F Bateson
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | | | - Barbara S Glenn
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
| | | | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Rebecca M Nachman
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | - Julie E Obbagy
- Nutrition Evidence Systematic Review Branch, Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA, USA
| | - Annette O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Elizabeth G Radke
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Evidence Synthesis Group, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Holger J Schünemann
- Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Beverley Shea
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Jos Verbeek
- Cochrane Work, Department of Public and Occupational Health, Academic Medical Centers Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| |
Collapse
|
3
|
Willet V, Dixit D, Fisher D, Bausch DG, Ogunsola F, Khabsa J, Akl EA, Baller A. Summary of WHO infection prevention and control guideline for Ebola and Marburg disease: a call for evidence based practice. BMJ 2024; 384:2811. [PMID: 38408787 PMCID: PMC10897755 DOI: 10.1136/bmj.p2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
| | - Devika Dixit
- World Health Organization, Geneva, Switzerland
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel G Bausch
- FIND, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | | |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
5
|
Piggott T, Moja L, Garcia CAC, Akl EA, Banzi R, Huttner B, Kredo T, Lavis JN, Schünemann HJ. User-experience testing of an evidence-to-decision framework for selecting essential medicines. PLOS Glob Public Health 2024; 4:e0002723. [PMID: 38206901 PMCID: PMC10783770 DOI: 10.1371/journal.pgph.0002723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
Essential medicine lists (EMLs) are important medicine prioritization tools used by the World Health Organization (WHO) EML and over 130 countries. The criteria used by WHO's Expert Committee on the Selection and Use of Essential Medicines has parallels to the GRADE Evidence-to-Decision (EtD) frameworks. In this study, we explored the EtD frameworks and a visual abstract as adjunctive tools to strengthen the integrate evidence and improve the transparency of decisions of EML applications. We conducted user-experience testing interviews of key EML stakeholders using Morville's honeycomb model. Interviews explored multifaceted dimensions (e.g., usability) on two EML applications for the 2021 WHO EML-long-acting insulin analogues for diabetes and immune checkpoint inhibitors for lung cancer. Using a pre-determined coding framework and thematic analysis we iteratively improved both the EtD framework and the visual abstract. We coded the transcripts of 17 interviews with 13 respondents in 103 locations of the interview texts across all dimensions of the user-experience honeycomb. Respondents felt the EtD framework and visual abstract presented complementary useful and findable adjuncts to the traditional EML application. They felt this would increase transparency and efficiency in evidence assessed by EML committees. As EtD frameworks are also used in health practice guidelines, including those by the WHO, respondents articulated that the adoption of the EtD by EML applications represents a tangible mechanism to align EMLs and guidelines, decrease duplication of work and improve coordination. Improvements were made to clarify instructions for the EtD and visual abstract, and to refine the design and content included. 'Availability' was added as an additional criterion for EML applications to highlight this criterion in alignment with WHO EML criteria. EtD frameworks and visual abstracts present additional important tools to communicate evidence and support decision-criteria in EML applications, which have global health impact. Access to essential medicines is important for achieving universal health coverage, and the development of essential medicine lists should be as evidence-based and trustworthy as possible.
Collapse
Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, Queens University, Kingston, ON, Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Carlos A. Cuello Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Rita Banzi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Benedikt Huttner
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, and Epidemiology and Biostatistics, Department of Global Health, Clinical Pharmacology, Stellenbosch University, Cape Town, South Africa
| | - John N. Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Sayfi S, Charide R, Elliott SA, Hartling L, Munan M, Stallwood L, Butcher NJ, Richards DP, Mathew JL, Suvada J, Akl EA, Kredo T, Mbuagbaw L, Motilall A, Baba A, Scott SD, Falavigna M, Klugar M, Friessová T, Lotfi T, Stevens A, Offringa M, Schünemann HJ, Pottie K. A multimethods randomized trial found that plain language versions improved adults understanding of health recommendations. J Clin Epidemiol 2024; 165:111219. [PMID: 38008266 DOI: 10.1016/j.jclinepi.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/17/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES To make informed decisions, the general population should have access to accessible and understandable health recommendations. To compare understanding, accessibility, usability, satisfaction, intention to implement, and preference of adults provided with a digital "Plain Language Recommendation" (PLR) format vs. the original "Standard Language Version" (SLV). STUDY DESIGN AND SETTING An allocation-concealed, blinded, controlled superiority trial and a qualitative study to understand participant preferences. An international on-line survey. 488 adults with some English proficiency. 67.8% of participants identified as female, 62.3% were from the Americas, 70.1% identified as white, 32.2% had a bachelor's degree as their highest completed education, and 42% said they were very comfortable reading health information. In collaboration with patient partners, advisors, and the Cochrane Consumer Network, we developed a plain language format of guideline recommendations (PLRs) to compare their effectiveness vs. the original standard language versions (SLVs) as published in the source guideline. We selected two recommendations about COVID-19 vaccine, similar in their content, to compare our versions, one from the World Health Organization (WHO) and one from Centers for Disease Control and Prevention (CDC). The primary outcome was understanding, measured as the proportion of correct responses to seven comprehension questions. Secondary outcomes were accessibility, usability, satisfaction, preference, and intended behavior, measured on a 1-7 scale. RESULTS Participants randomized to the PLR group had a higher proportion of correct responses to the understanding questions for the WHO recommendation (mean difference [MD] of 19.8%, 95% confidence interval [CI] 14.7-24.9%; P < 0.001) but this difference was smaller and not statistically significant for the CDC recommendation (MD of 3.9%, 95% CI -0.7% to 8.3%; P = 0.096). However, regardless of the recommendation, participants found the PLRs more accessible, (MD of 1.2 on the seven-point scale, 95% CI 0.9-1.4%; P < 0.001) and more satisfying (MD of 1.2, 95% CI 0.9-1.4%; P < 0.001). They were also more likely to follow the recommendation if they had not already followed it (MD of 1.2, 95% CI 0.7-1.8%; P < 0.001) and share it with other people they know (MD of 1.9, 95% CI 0.5-1.2%; P < 0.001). There was no significant difference in the preference between the two formats (MD of -0.3, 95% CI -0.5% to 0.03%; P = 0.078). The qualitative interviews supported and contextualized these findings. CONCLUSION Health information provided in a PLR format improved understanding, accessibility, usability, and satisfaction and thereby has the potential to shape public decision-making behavior.
Collapse
Affiliation(s)
- Shahab Sayfi
- Department of Biology, Faculty of Science, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario N6A 5C1, Canada; Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada
| | - Rana Charide
- Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada
| | - Sarah A Elliott
- Department of Pediatrics, Faculty of Medicine and Dentistry, Alberta Research Center for Health Evidence, University of Alberta, Edmonton, Alberta, Canada; Cochrane Child Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, Alberta Research Center for Health Evidence, University of Alberta, Edmonton, Alberta, Canada; Cochrane Child Health, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Munan
- Department of Pediatrics, Faculty of Medicine and Dentistry, Alberta Research Center for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Stallwood
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | | | - Joseph L Mathew
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jozef Suvada
- National Evidence and Quality Platform, St. Elizabeth University of Public Health and Social Science, Research Dept., Nam. 1. Maja 1, 81000 Bratislava, Slovak Republic; Experts Consortium for COVID-19, Advisor to Government of Slovak Republic, Bratislava, Slovak Republic; WHO Executive Board, Geneva, Switzerland
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Capetown, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, 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
| | - Ashley Motilall
- Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Maicon Falavigna
- National Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tereza Friessová
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada
| | - Adrienne Stevens
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario K1A 0K9, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario M5T 3M6, Canada; Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario M5G 1X8, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Kevin Pottie
- Schulich School of Medicine & Dentistry, Western University, London, Ontario N6A 5C1, Canada; Department of Family Medicine, Western University, London, Ontario, Canada.
| |
Collapse
|
7
|
Mustafa RA, El Mikati IK, Murad MH, Hultcrantz M, Steingart KR, Yang B, Leeflang MMG, Akl EA, Dahm P, Schünemann HJ. GRADE guidance 37: rating imprecision in a body of evidence on test accuracy. J Clin Epidemiol 2024; 165:111189. [PMID: 38613246 DOI: 10.1016/j.jclinepi.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/07/2023] [Accepted: 10/13/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVES To provide guidance on rating imprecision in a body of evidence assessing the accuracy of a single test. This guide will clarify when Grading of Recommendations Assessment, Development and Evaluation (GRADE) users should consider rating down the certainty of evidence by one or more levels for imprecision in test accuracy. STUDY DESIGN AND SETTING A project group within the GRADE working group conducted iterative discussions and presentations at GRADE working group meetings to produce this guidance. RESULTS Before rating the certainty of evidence, GRADE users should define the target of their certainty rating. GRADE recommends setting judgment thresholds defining what they consider a very accurate, accurate, inaccurate, and very inaccurate test. These thresholds should be set after considering consequences of testing and effects on people-important outcomes. GRADE's primary criterion for judging imprecision in test accuracy evidence is considering confidence intervals (i.e., CI approach) of absolute test accuracy results (true and false, positive, and negative results in a cohort of people). Based on the CI approach, when a CI appreciably crosses the predefined judgment threshold(s), one should consider rating down certainty of evidence by one or more levels, depending on the number of thresholds crossed. When the CI does not cross judgment threshold(s), GRADE suggests considering the sample size for an adequately powered test accuracy review (optimal or review information size [optimal information size (OIS)/review information size (RIS)]) in rating imprecision. If the combined sample size of the included studies in the review is smaller than the required OIS/RIS, one should consider rating down by one or more levels for imprecision. CONCLUSION This paper extends previous GRADE guidance for rating imprecision in single test accuracy systematic reviews and guidelines, with a focus on the circumstances in which one should consider rating down one or more levels for imprecision.
Collapse
Affiliation(s)
- Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Centre, 3901 Rainbow Blvd, MS3002, Kansas City, KS 61160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 1st, ST, SW, Rochester, MN 55902, USA
| | - Monica Hultcrantz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodav. 18 A, SE-171 77 Stockholm, Sweden
| | - Karen R Steingart
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Bada Yang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Clinical Epidemiology and Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam, Meibergdreef 9, P.O.Box 227001100 DE, Amsterdam, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section 112D, One Veterans Drive, Minneapolis, MN 55417, USA
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8 Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milano, Italy; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Breisgau, Germany
| |
Collapse
|
8
|
Iannizzi C, Akl EA, Anslinger E, Weibel S, Kahale LA, Aminat AM, Piechotta V, Skoetz N. Methods and guidance on conducting, reporting, publishing, and appraising living systematic reviews: a scoping review. Syst Rev 2023; 12:238. [PMID: 38098023 PMCID: PMC10722674 DOI: 10.1186/s13643-023-02396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The living systematic review (LSR) approach is based on ongoing surveillance of the literature and continual updating. Most currently available guidance documents address the conduct, reporting, publishing, and appraisal of systematic reviews (SRs), but are not suitable for LSRs per se and miss additional LSR-specific considerations. In this scoping review, we aim to systematically collate methodological guidance literature on how to conduct, report, publish, and appraise the quality of LSRs and identify current gaps in guidance. METHODS A standard scoping review methodology was used. We searched MEDLINE (Ovid), EMBASE (Ovid), and The Cochrane Library on August 28, 2021. As for searching gray literature, we looked for existing guidelines and handbooks on LSRs from organizations that conduct evidence syntheses. The screening was conducted by two authors independently in Rayyan, and data extraction was done in duplicate using a pilot-tested data extraction form in Excel. Data was extracted according to four pre-defined categories for (i) conducting, (ii) reporting, (iii) publishing, and (iv) appraising LSRs. We mapped the findings by visualizing overview tables created in Microsoft Word. RESULTS Of the 21 included papers, methodological guidance was found in 17 papers for conducting, in six papers for reporting, in 15 papers for publishing, and in two papers for appraising LSRs. Some of the identified key items for (i) conducting LSRs were identifying the rationale, screening tools, or re-revaluating inclusion criteria. Identified items of (ii) the original PRISMA checklist included reporting the registration and protocol, title, or synthesis methods. For (iii) publishing, there was guidance available on publication type and frequency or update trigger, and for (iv) appraising, guidance on the appropriate use of bias assessment or reporting funding of included studies was found. Our search revealed major evidence gaps, particularly for guidance on certain PRISMA items such as reporting results, discussion, support and funding, and availability of data and material of a LSR. CONCLUSION Important evidence gaps were identified for guidance on how to report in LSRs and appraise their quality. Our findings were applied to inform and prepare a PRISMA 2020 extension for LSR.
Collapse
Affiliation(s)
- Claire Iannizzi
- Institute of Population Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Elie A Akl
- Department of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Eva Anslinger
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Lara A Kahale
- Editorial and Methods Department, Cochrane Central Executive, Cochrane, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK
| | - Abina Mosunmola Aminat
- Rafic Hariri School of Nursing, American University of Beirut, Riad El Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Vanessa Piechotta
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Nicole Skoetz
- Institute of Population Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
9
|
Murad MH, Verbeek J, Schwingshackl L, Filippini T, Vinceti M, Akl EA, Morgan RL, Mustafa RA, Zeraatkar D, Senerth E, Street R, Lin L, Falck-Ytter Y, Guyatt G, Schünemann HJ. GRADE GUIDANCE 38: Updated guidance for rating up certainty of evidence due to a dose-response gradient. J Clin Epidemiol 2023; 164:45-53. [PMID: 37777140 DOI: 10.1016/j.jclinepi.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION This updated guidance from the Grading of Recommendations Assessment, Development, and Evaluation addresses rating up certainty of evidence due to a dose-response gradient (DRG) observed in synthesis of intervention and exposure studies. STUDY DESIGN AND SETTING This guidance was developed using iterative discussions and consensus in multiple meetings and was presented to attendees of the Grading of Recommendations Assessment, Development, and Evaluation Working Group meeting for feedback in November 2022 and for final approval in May 2023. RESULTS The guidance consists of two steps. The first is to determine whether the DRG is credible. We describe five items for assessing credibility: a) is DRG identified using a proper analytical approach; b) is confounding the cause of the DRG; c) is there serious concern about ecological bias; d) is the DRG consistent across studies; and e) is there indirect evidence supporting the DRG. The first two of these items are the most critical. If the DRG was judged to be credible, then the second step is to apply the DRG domain and consider rating up, but only by one level due to the concern about residual confounding. CONCLUSION Systematic review authors should only rate up certainty in evidence when a DRG is deemed credible.
Collapse
Affiliation(s)
- M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA; Evidence Foundation, Cleveland Heights, OH, USA.
| | - Jos Verbeek
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Modena, Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon; Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca L Morgan
- Evidence Foundation, Cleveland Heights, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Reem A Mustafa
- Evidence Foundation, Cleveland Heights, OH, USA; Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dena Zeraatkar
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | | | - Renee Street
- South African Medical Research Council, Environment & Health Research Unit, South Africa
| | - Lifeng Lin
- Department of Statistics, University of Arizona Medical Center-South Campus, Tucson, Arizona, USA
| | - Yngve Falck-Ytter
- Evidence Foundation, Cleveland Heights, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | - Gordon Guyatt
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| |
Collapse
|
10
|
Langford BJ, Leung V, Lo J, Akl EA, Nieuwlaat R, Lotfi T, Brown KA, Daneman N, Schwartz KL, Schünemann HJ. Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey. EClinicalMedicine 2023; 65:102257. [PMID: 37842549 PMCID: PMC10568086 DOI: 10.1016/j.eclinm.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and whether they incorporate principles of antimicrobial stewardship. Methods We performed a systematic survey which included a search using the concepts "antibiotic/antimicrobial" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc. Findings Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n = 52, 83%) and less commonly antibiotic selection (n = 13, 21%), and duration of therapy (n = 15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship. Interpretation There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19. Funding This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.
Collapse
Affiliation(s)
- Bradley J. Langford
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Canada
- Toronto East Health Network, Toronto, Canada
| | - Jennifer Lo
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Unity Health Toronto, Toronto, Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
- Humanitas University, Milan, Italy
| |
Collapse
|
11
|
Khabsa J, Yaacoub S, Omair MA, Al Rayes H, Akl EA. Methodology for the adolopment of recommendations for the treatment of rheumatoid arthritis in the Kingdom of Saudi Arabia. BMC Med Res Methodol 2023; 23:224. [PMID: 37817088 PMCID: PMC10563247 DOI: 10.1186/s12874-023-02031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Currently, there are no guidelines for the treatment of rheumatoid arthritis (RA) tailored to the context of the Kingdom of Saudi Arabia (KSA). Adaptation of guidelines accounts for contextual factors and becomes more efficient than de novo guideline development when relevant, good quality, and up-to-date guidelines are available. The objective of this study is to describe the methodology used for the adolopment of the 2021 American College of Rheumatology (ACR) guidelines for the treatment of RA in the KSA. METHODS We followed the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE)-ADOLOPMENT methodology. The adolopment KSA panel included relevant stakeholders and leading contributors to the original guidelines. We developed a list of five adaptation-relevant prioritization criteria that the panelists applied to the original recommendations. We updated the original evidence profiles with newly published studies identified by the panelists. We constructed Evidence to Decision (EtD) tables including contextual information from the KSA setting. We used the PanelVoice function of GRADEPro Guideline Development Tool (GDT) to obtain the panel's judgments on the EtD criteria ahead of the panel meeting. Following the meeting, we used the PANELVIEW instrument to obtain the panel's evaluation of the process. RESULTS The KSA panel prioritized five recommendations, for which one evidence profile required updating. Out of five adoloped recommendations, two were modified in terms of direction, and one was modified in terms of certainty of the evidence. Criteria driving the modifications in direction were valuation of outcomes, balance of effects, cost, and acceptability. The mean score on the 7-point scale items of the PANELVIEW instrument had an average of 6.47 (SD = 0.18) across all items. CONCLUSION The GRADE-ADOLOPMENT methodology proved to be efficient. The panel assessed the process and outcome positively. Engagement of stakeholders proved to be important for the success of this project.
Collapse
Affiliation(s)
- Joanne Khabsa
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Yaacoub
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Al Rayes
- Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Riad-El-Solh, P.O. Box: 11-0236, Beirut, 1107 2020 Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON Canada
| |
Collapse
|
12
|
Murad MH, Wang Z, Chu H, Lin L, El Mikati IK, Khabsa J, Akl EA, Nieuwlaat R, Schuenemann HJ, Riaz IB. Proposed triggers for retiring a living systematic review. BMJ Evid Based Med 2023; 28:348-352. [PMID: 36889900 PMCID: PMC10579491 DOI: 10.1136/bmjebm-2022-112100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 03/10/2023]
Abstract
Living systematic reviews (LSRs) are systematic reviews that are continually updated, incorporating relevant new evidence as it becomes available. LSRs are critical for decision-making in topics where the evidence continues to evolve. It is not feasible to continue to update LSRs indefinitely; however, guidance on when to retire LSRs from the living mode is not clear. We propose triggers for making such a decision. The first trigger is to retire LSRs when the evidence becomes conclusive for the outcomes that are required for decision-making. Conclusiveness of evidence is best determined based on the GRADE certainty of evidence construct, which is more comprehensive than solely relying on statistical considerations. The second trigger to retire LSRs is when the question becomes less pertinent for decision-making as determined by relevant stakeholders, including people affected by the problem, healthcare professionals, policymakers and researchers. LSRs can also be retired from a living mode when new studies are not anticipated to be published on the topic and when resources become unavailable to continue updating. We describe examples of retired LSRs and apply the proposed approach using one LSR about adjuvant tyrosine kinase inhibitors in high-risk renal cell carcinoma that we retired from a living mode and published its last update.
Collapse
Affiliation(s)
- Mohammad Hassan Murad
- Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Zhen Wang
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Haitao Chu
- Department of Biostatistics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Lifeng Lin
- Department of Statistics, University of Arizona Medical Center-South Campus, Tucson, Arizona, USA
| | | | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schuenemann
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster University, GRADE Center, Hamilton, Ontario, Canada
- Institute for Evidence in Medicine, University of Freiburg, Freiburg, Germany
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Irbaz Bin Riaz
- Mayo Clinic, Phoenix, Arizona, USA
- Mass General Brigham Inc, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Akl EA, Cuker A, Mustafa RA, Nieuwlaat R, Stevens A, Schünemann HJ. Prospective collaborative recommendation development: a novel model for more timely and trustworthy guidelines. J Clin Epidemiol 2023; 162:156-159. [PMID: 37648070 DOI: 10.1016/j.jclinepi.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adrienne Stevens
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| |
Collapse
|
14
|
Sbaity E, Zahwe M, Helou V, Bahsoun R, Hassan Z, Abi Khalil P, Akl EA. Health Research Collaborations by Academic Entities: A Systematic Review. Acad Med 2023; 98:1220-1227. [PMID: 37232854 DOI: 10.1097/acm.0000000000005277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To review the literature on health research collaborations by academic entities and to identify the main phases, components, and concepts of these research collaborations. METHOD The authors conducted a systematic review of the literature, searching 4 databases in March 2022 for studies on health research collaboration between an academic entity (individual, group, or institution) and any other entity included. They excluded non-health-related studies and studies in which collaboration was not for the purpose of research. From included studies, reviewers abstracted data about the 4 main phases of research collaborations (initiation, conduct, monitoring, and evaluation) and synthesized their corresponding components and concepts using thematic analysis method. RESULTS A total of 59 studies met inclusion criteria. These studies described building research collaborations between an academic entity and other academic entities (n = 29; 49%), communities (n = 28; 47%), industry (n = 7; 12%), and/or governmental entities (n = 4; 7%). Of the 59 studies, 22 addressed 2 phases of collaboration, 20 addressed 3 phases, and 17 addressed all 4 phases. All included studies described at least 1 of the components relevant to the initiation phase and at least 1 relevant to the conduct phase. Team structure was the most common component discussed in relation to the initiation phase (n = 48; 81%), and team dynamics was the most common component discussed in relation to the conduct phase (n = 55; 93%). At least 1 of the components relevant to the monitoring phase was reported in 36 studies, and at least 1 component relevant to the evaluation phase was reported in 28 studies. CONCLUSIONS This review provides important information for groups aiming to engage in collaborative research. The synthesized list of collaboration phases and their components can serve as a road map for collaborators at different steps of their research.
Collapse
Affiliation(s)
- Eman Sbaity
- E. Sbaity is assistant professor, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Zahwe
- M. Zahwe is postdoctoral research associate, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- V. Helou is a medical student, American University of Beirut, Beirut, Lebanon; ORCID: https://orcid.org/0000-0003-4826-1659
| | - Reem Bahsoun
- R. Bahsoun is a medical student, American University of Beirut, Beirut, Lebanon
| | - Zeina Hassan
- Z. Hassan is research assistant, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pamela Abi Khalil
- P. Abi Khalil is senior research assistant, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie A Akl
- E.A. Akl is professor, Department of Medicine, American University of Beirut, Beirut, Lebanon, and professor, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; ORCID: https://orcid.org/0000-0002-3444-8618
| |
Collapse
|
15
|
Fahed G, Fares AH, Ghosn A, Greige A, Hebbo E, Naja K, Moukarzel P, Haddad S, Finianos A, Honein G, Akl EA. The lived experiences of patients with cancer during the COVID-19 pandemic: a qualitative study. Ecancermedicalscience 2023; 17:1598. [PMID: 37799953 PMCID: PMC10550325 DOI: 10.3332/ecancer.2023.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 10/07/2023] Open
Abstract
Background The objective of this study was to explore the impact of COVID-19 on the lived experiences of patients with cancer in Lebanon. Methods We adopted a descriptive phenomenological approach. We included adults who had been diagnosed with cancer before the pandemic and undergoing treatment at the American University of Beirut Medical Centre. We conducted virtual, semi-structured in-depth interviews with either video or audio recordings. Two team members coded the transcripts independently and identified common themes and patterns. Results We recruited 11 participants for the study. The analysis identified the following six themes: perceived seriousness of COVID-19, fear of COVID-19 versus fear of cancer, coping mechanisms, treatment availability and accessibility, compliance with public health and social measures and precautionary measures in the healthcare system. The coping mechanisms included staying positive, seeking normalcy, using family support, religiosity and fatalism. Conclusion Faced with many challenges during the COVID-19 pandemic, patients with cancer resorted to a range of coping strategies.
Collapse
Affiliation(s)
- Gracia Fahed
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
- Equal contribution
| | - Angie H Fares
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
- Equal contribution
| | - Aya Ghosn
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
- Equal contribution
| | - Alain Greige
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
- Equal contribution
| | - Elsa Hebbo
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
- Equal contribution
| | - Kim Naja
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
- Equal contribution
| | - Pamela Moukarzel
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
| | - Salame Haddad
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
| | - Antoine Finianos
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
| | - Gladys Honein
- American University of Beirut Hariri School of Nursing, Beirut 1107, Lebanon
| | - Elie A Akl
- American University of Beirut Faculty of Medicine, Beirut 1107, Lebanon
| |
Collapse
|
16
|
Helou V, Mouzahem F, Makarem A, Noureldine HA, El-Khoury R, Al Oweini D, Halak R, Hneiny L, Khabsa J, Akl EA. Conflict of interest and funding in health communication on social media: a systematic review. BMJ Open 2023; 13:e072258. [PMID: 37580091 PMCID: PMC10432670 DOI: 10.1136/bmjopen-2023-072258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES To synthesise the available evidence on the reporting of conflicts of interest (COI) by individuals posting health messages on social media, and on the reporting of funding sources of studies cited in health messages on social media. DATA SOURCES MEDLINE (OVID) (2005-March 2022), Embase (2005-March 2022) and Google Scholar (2005-August 2022), supplemented with a review of reference lists and forward citation tracking. DESIGN Reviewers selected eligible studies and abstracted data in duplicate and independently. We appraised the quality of the included studies using the Mixed Methods Appraisal Tool. We summarised the results in both narrative and tabular formats. We followed the PRISMA 2020 checklist for reporting our study. RESULTS Of a total of 16 645 retrieved citations, we included 17 eligible studies. The frequency of reporting of conflicts of interest varied between 0% and 60%, but it was mostly low. In addition, a significant proportion, ranging between 15% and 80%, of healthcare professionals using social media have financial relationships with industry. However, three studies assessed the proportion of conflicts of interest of physicians identified through Open Payment Database but not reported by the authors. It was found that 98.7-100% of these relationships with industry are not reported when communicating health-related information. Also, two studies showed that there is evidence of a potential association between COI and the content of posting. No data was found on the reporting of funding sources of studies cited in health messages on social media. CONCLUSIONS While a significant proportion of healthcare professionals using social media have financial relationships with industry, lack of reporting on COI and undisclosed COI are common. We did not find studies on the reporting of funding sources of studies cited in health messages on social media. TRIAL REGISTRATION dx.doi.org/10.17504/protocols.io.5jyl8jj4rg2w/v1.
Collapse
Affiliation(s)
- Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatima Mouzahem
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Adham Makarem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Hussein A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Rayane El-Khoury
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine, New York, New York, USA
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dana Al Oweini
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Razan Halak
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
- Wegner Health Sciences Library, University of South Dakota, Vermillion, South Dakota, USA
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
17
|
El Mikati IK, Hoteit R, Harb T, El Zein O, Piggott T, Melki J, Mustafa RA, Akl EA. Defining Misinformation and Related Terms in Health-Related Literature: Scoping Review. J Med Internet Res 2023; 25:e45731. [PMID: 37556184 PMCID: PMC10414029 DOI: 10.2196/45731] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Misinformation poses a serious challenge to clinical and policy decision-making in the health field. The COVID-19 pandemic amplified interest in misinformation and related terms and witnessed a proliferation of definitions. OBJECTIVE We aim to assess the definitions of misinformation and related terms used in health-related literature. METHODS We conducted a scoping review of systematic reviews by searching Ovid MEDLINE, Embase, Cochrane, and Epistemonikos databases for articles published within the last 5 years up till March 2023. Eligible studies were systematic reviews that stated misinformation or related terms as part of their objectives, conducted a systematic search of at least one database, and reported at least 1 definition for misinformation or related terms. We extracted definitions for the terms misinformation, disinformation, fake news, infodemic, and malinformation. Within each definition, we identified concepts and mapped them across misinformation-related terms. RESULTS We included 41 eligible systematic reviews, out of which 32 (78%) reviews addressed the topic of public health emergencies (including the COVID-19 pandemic) and contained 75 definitions for misinformation and related terms. The definitions consisted of 20 for misinformation, 19 for disinformation, 10 for fake news, 24 for infodemic, and 2 for malinformation. "False/inaccurate/incorrect" was mentioned in 15 of 20 definitions of misinformation, 13 of 19 definitions of disinformation, 5 of 10 definitions of fake news, 6 of 24 definitions of infodemic, and 0 of 2 definitions of malinformation. Infodemic had 19 of 24 definitions addressing "information overload" and malinformation had 2 of 2 definitions with "accurate" and 1 definition "used in the wrong context." Out of all the definitions, 56 (75%) were referenced from other sources. CONCLUSIONS While the definitions of misinformation and related terms in the health field had inconstancies and variability, they were largely consistent. Inconstancies related to the intentionality in misinformation definitions (7 definitions mention "unintentional," while 5 definitions have "intentional"). They also related to the content of infodemic (9 definitions mention "valid and invalid info," while 6 definitions have "false/inaccurate/incorrect"). The inclusion of concepts such as "intentional" may be difficult to operationalize as it is difficult to ascertain one's intentions. This scoping review has the strength of using a systematic method for retrieving articles but does not cover all definitions in the extant literature outside the field of health. This scoping review of the health literature identified several definitions for misinformation and related terms, which showed variability and included concepts that are difficult to operationalize. Health practitioners need to exert caution before labeling a piece of information as misinformation or any other related term and only do so after ascertaining accurateness and sometimes intentionality. Additional efforts are needed to allow future consensus around clear and operational definitions.
Collapse
Affiliation(s)
- Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Reem Hoteit
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Tarek Harb
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ola El Zein
- University Libraries, American University of Beirut, Beirut, Lebanon
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, Queens University, Kingston, ON, Canada
| | - Jad Melki
- Institute of Media Research and Training, Lebanese American University, Beirut, Lebanon
| | - Reem A Mustafa
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
18
|
Tugwell P, Welch V, Magwood O, Todhunter-Brown A, Akl EA, Concannon TW, Khabsa J, Morley R, Schunemann H, Lytvyn L, Agarwal A, Antequera A, Avey MT, Campbell P, Chang C, Chang S, Dans L, Dewidar O, Ghersi D, Graham ID, Hazlewood G, Hilgart J, Horsley T, John D, Jull J, Maxwell LJ, McCutcheon C, Munn Z, Nonino F, Pardo Pardo J, Parker R, Pottie K, Rada G, Riddle A, Synnot A, Ghogomu ET, Tomlinson E, Toupin-April K, Petkovic J. Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses. Syst Rev 2023; 12:134. [PMID: 37533051 PMCID: PMC10394942 DOI: 10.1186/s13643-023-02279-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/18/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Involving collaborators and partners in research may increase relevance and uptake, while reducing health and social inequities. Collaborators and partners include people and groups interested in health research: health care providers, patients and caregivers, payers of health research, payers of health services, publishers, policymakers, researchers, product makers, program managers, and the public. Evidence syntheses inform decisions about health care services, treatments, and practice, which ultimately affect health outcomes. Our objectives are to: A. Identify, map, and synthesize qualitative and quantitative findings related to engagement in evidence syntheses B. Explore how engagement in evidence synthesis promotes health equity C. Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement in evidence syntheses METHODS: Our diverse, international team will develop guidance for engagement with collaborators and partners throughout multiple sequential steps using an integrated knowledge translation approach: 1. Reviews. We will co-produce 1 scoping review, 3 systematic reviews and 1 evidence map focusing on (a) methods, (b) barriers and facilitators, (c) conflict of interest considerations, (d) impacts, and (e) equity considerations of engagement in evidence synthesis. 2. Methods study, interviews, and survey. We will contextualise the findings of step 1 by assessing a sample of evidence syntheses reporting on engagement with collaborators and partners and through conducting interviews with collaborators and partners who have been involved in producing evidence syntheses. We will use these findings to develop draft guidance checklists and will assess agreement with each item through an international survey. 3. CONSENSUS The guidance checklists will be co-produced and finalised at a consensus meeting with collaborators and partners. 4. DISSEMINATION We will develop a dissemination plan with our collaborators and partners and work collaboratively to improve adoption of our guidance by key organizations. CONCLUSION Our international team will develop guidance for collaborator and partner engagement in health care evidence syntheses. Incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.
Collapse
Affiliation(s)
- Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 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
| | - Vivian Welch
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Olivia Magwood
- Bruyere Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Alex Todhunter-Brown
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - 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
| | - Thomas W Concannon
- The RAND Corporation and Tufts University School of Medicine, Boston, MA, USA
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Holger Schunemann
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Cochrane Canada, Hamilton, ON, Canada
| | | | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marc T Avey
- Canadian Council On Animal Care, Ottawa, Canada
| | - Pauline Campbell
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christine Chang
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Leonila Dans
- Department of Clinical Epidemiology, University of the Philippines-Manila, Manila, Philippines
| | | | - Davina Ghersi
- Research Translation, National Health and Medical Research Council, Canberra, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ian D Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Tanya Horsley
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Denny John
- PharmaQuant, Kolkata, India
- Center for Public Health Research (CPHR), Kolkata, India
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Chris McCutcheon
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zachary Munn
- Faculty of Health and Medical Sciences, JBI, University of Adelaide, Adelaide, South Australia, Australia
| | - Francesco Nonino
- Unit of Epidemiology and Statistics, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Jordi Pardo Pardo
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa Methods Centre, Ottawa, Canada
| | - Roses Parker
- Cochrane Pain Palliative and Supportive Care, Oxford University Hospitals Trust, Oxford, England
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile
- UC Evidence Centre and Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison Riddle
- Bruyere Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Anneliese Synnot
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne Victoria, 3004, Australia
- Centre for Health Communication and Participation, School of Public Health and Psychological Sciences, La Trobe University, Plenty Rd, Bundoora, VIC, 3086, Australia
| | - Elizabeth Tanjong Ghogomu
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Eve Tomlinson
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
| | - Jennifer Petkovic
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Bruyere Research Institute, Ottawa, Canada.
| |
Collapse
|
19
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
20
|
Yaacoub S, Chamseddine F, Jaber F, Blazic I, Frija G, Akl EA. Exploring the concordance of recommendations across guidelines on chest imaging for the diagnosis and management of COVID-19: A proposed methodological approach based on a case study. PLoS One 2023; 18:e0288359. [PMID: 37498898 PMCID: PMC10374079 DOI: 10.1371/journal.pone.0288359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To describe a methodological approach to explore the concordance of recommendations across guidelines and its application to the case of the WHO recommendations on chest imaging for the diagnosis and management of COVID-19. STUDY DESIGN AND SETTING We followed a methodological approach applied to a case study that included: defining the 'reference guideline' (i.e., the WHO guidance) and the 'reference recommendations'; searching for 'related guidelines' and identifying 'related recommendations'; constructing the PICO for the recommendations; assessing the matching of the PICO of each related recommendation to the PICO corresponding reference recommendation; and assessing the concordance between the PICO-matching recommendations. RESULTS We identified a total of 89 related recommendations from 22 related guidelines. Out of the 89 related recommendations, 43 partly matched and 1 entirely matched one of the reference recommendations, and out of these, 8 were concordant with one of the reference recommendations. When considering the seven reference recommendations, they had a median of 12 related recommendations (range 3-17), a median of 7 PICO-matching recommendations (range 0-13), and a median of 1 concordant recommendation (range 0-4). CONCLUSION Following a detailed methodological approach, we were able to explore the concordance between our reference recommendations and related recommendations from other guidelines. A relatively low percentage of recommendations was concordant.
Collapse
Affiliation(s)
- Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | | | - Farah Jaber
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Ivana Blazic
- Clinical Hospital Centre Zemun, Belgrade, Serbia
| | | | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence & Impact, McMaster University, Ontario, Canada
| |
Collapse
|
21
|
Vieira AM, Szczepanik G, de Waure C, Tricco AC, Oliver S, Stojanovic J, Ribeiro PAB, Pollock D, Akl EA, Lavis J, Kuchenmuller T, Bragge P, Langer L, Bacon S. Identifying priority questions regarding rapid systematic reviews' methods: protocol for an eDelphi study. BMJ Open 2023; 13:e069856. [PMID: 37419644 PMCID: PMC10335584 DOI: 10.1136/bmjopen-2022-069856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/22/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Rapid systematic reviews (RRs) have the potential to provide timely information to decision-makers, thus directly impacting healthcare. However, consensus regarding the most efficient approaches to performing RRs and the presence of several unaddressed methodological issues pose challenges. With such a large potential research agenda for RRs, it is unclear what should be prioritised. OBJECTIVE To elicit a consensus from RR experts and interested parties on what are the most important methodological questions (from the generation of the question to the writing of the report) for the field to address in order to guide the effective and efficient development of RRs. METHODS AND ANALYSIS An eDelphi study will be conducted. Researchers with experience in evidence synthesis and other interested parties (eg, knowledge users, patients, community members, policymaker, industry, journal editors and healthcare providers) will be invited to participate. The following steps will be taken: (1) a core group of experts in evidence synthesis will generate the first list of items based on the available literature; (2) using LimeSurvey, participants will be invited to rate and rank the importance of suggested RR methodological questions. Questions with open format responses will allow for modifications to the wording of items or the addition of new items; (3) three survey rounds will be performed asking participants to re-rate items, with items deemed of low importance being removed at each round; (4) a list of items will be generated with items believed to be of high importance by ≥75% of participants being included and (5) this list will be discussed at an online consensus meeting that will generate a summary document containing the final priority list. Data analysis will be performed using raw numbers, means and frequencies. ETHICS AND DISSEMINATION This study was approved by the Concordia University Human Research Ethics Committee (#30015229). Both traditional, for example, scientific conference presentations and publication in scientific journals, and non-traditional, for example, lay summaries and infographics, knowledge translation products will be created.
Collapse
Affiliation(s)
- Ariany M Vieira
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Québec, Canada
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, Québec, Canada
| | - Geneviève Szczepanik
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, Québec, Canada
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sandy Oliver
- University College London Institute of Education, London, UK
| | - Jovana Stojanovic
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Québec, Canada
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, Québec, Canada
| | - Paula A B Ribeiro
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, Québec, Canada
| | - Danielle Pollock
- Health Evidence Synthesis, Recommendations and Impact, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - 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
| | - John Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Affiliate Scientist, Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Tanja Kuchenmuller
- Research for Health Department,Science Division, World Health Organization, Geneva, Switzerland
| | - Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, BehaviourWorks Australia, Monash University, Melbourne, Victoria, Australia
| | - Laurenz Langer
- South Africa Centre for Evidence, Johannesburg, South Africa
| | - Simon Bacon
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Québec, Canada
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, Québec, Canada
| |
Collapse
|
22
|
Goldkuhle M, Guyatt GH, Kreuzberger N, Akl EA, Dahm P, van Dalen EC, Hemkens LG, Klugar M, Mustafa RA, Nonino F, Schünemann HJ, Trivella M, Skoetz N. GRADE concept 4: rating the certainty of evidence when study interventions or comparators differ from PICO targets. J Clin Epidemiol 2023; 159:40-48. [PMID: 37146659 DOI: 10.1016/j.jclinepi.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This Grading of Recommendations Assessment, Development and Evaluation (GRADE) concept article offers systematic reviewers, guideline authors, and other users of evidence assistance in addressing randomized trial situations in which interventions or comparators differ from those in the target people, interventions, comparators, and outcomes. To clarify what GRADE considers under indirectness of interventions and comparators, we focus on a particular example: when comparator arm participants receive some or all aspects of the intervention management strategy (treatment switching). STUDY DESIGN AND SETTING An interdisciplinary panel of the GRADE working group members developed this concept article through an iterative review of examples in multiple teleconferences, small group sessions, and e-mail correspondence. After presentation at a GRADE working group meeting in November 2022, attendees approved the final concept paper, which we support with examples from systematic reviews and individual trials. RESULTS In the presence of safeguards against risk of bias, trials provide unbiased estimates of the effect of an intervention on the people as enrolled, the interventions as implemented, the comparators as implemented, and the outcomes as measured. Within the GRADE framework, differences in the people, interventions, comparators, and outcomes elements between the review or guideline recommendation targets and the trials as implemented constitute issues of indirectness. The intervention or comparator group management strategy as implemented, when it differs from the target comparator, constitutes one potential source of indirectness: Indirectness of interventions and comparators-comparator group receipt of the intervention constitutes a specific subcategory of said indirectness. The proportion of comparator arm participants that received the intervention and the apparent magnitude of effect bear on whether one should rate down, and if one does, to what extent. CONCLUSION Treatment switching and other differences between review or guideline recommendation target interventions and comparators vs. interventions and comparators as implemented in otherwise relevant trials are best considered issues of indirectness.
Collapse
Affiliation(s)
- Marius Goldkuhle
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada, McMaster GRADE Centre and Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
| | - Nina Kreuzberger
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon, P.O.Box 11-0236 and Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section 112D, One Veterans Drive, Minneapolis, Minnesota 55417
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, the Netherlands
| | - Lars G Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, 100 00 Prague, Czech Republic
| | - Reem A Mustafa
- Department of Medicine and Population Health, University of Kansas Health System, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario L8S 4K1, Canada
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Epidemiology and Statistics, Cochrane Review Group Multiple Sclerosis and Rare Diseases of the CNS, Via Altura 3, 40139 Bologna, Italy
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Cochrane Canada, Hamilton, Ontario, Canada
| | - Marialene Trivella
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, UK; Department of Population Health, London School of Hygiene and Tropical Medicine, London
| | - Nicole Skoetz
- Evidence-based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| |
Collapse
|
23
|
Schünemann HJ, Brennan S, Akl EA, Hultcrantz M, Alonso-Coello P, Xia J, Davoli M, Rojas MX, Meerpohl JJ, Flottorp S, Guyatt G, Mustafa RA, Langendam M, Dahm P. The development methods of official GRADE articles and requirements for claiming the use of GRADE - A statement by the GRADE guidance group. J Clin Epidemiol 2023; 159:79-84. [PMID: 37211327 DOI: 10.1016/j.jclinepi.2023.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/26/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote, Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milano, Italy.
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote, Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut Medical Center, P.O.Box 11-0236/CRI (E15), Riad-El-Solh, Beirut 1107 2020, Lebanon
| | - Monica Hultcrantz
- HTA Region Stockholm, Centre for Health Economics, Informatics and Health Services Research (CHIS), Stockholm Health Care Services, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona 08025, Spain
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo China, Ningbo, China; Academic Unit of Lifespan and Population Health, School of Medicine, The University of Nottingham, Nottingham, UK
| | - Marina Davoli
- Department of Epidemiology Lazio Region, Via Cristoforo Colombo 112, 00147
| | - Maria Ximena Rojas
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona 08025, Spain
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Signe Flottorp
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote, Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote, Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Miranda Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health institute, Amsterdam, The Netherlands
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
24
|
Makarem A, Mroué R, Makarem H, Diab L, Hassan B, Khabsa J, Akl EA. Conflict of interest in the peer review process: A survey of peer review reports. PLoS One 2023; 18:e0286908. [PMID: 37289790 PMCID: PMC10249818 DOI: 10.1371/journal.pone.0286908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVES To assess the extent to which peer reviewers and journals editors address study funding and authors' conflicts of interests (COI). Also, we aimed to assess the extent to which peer reviewers and journals editors reported and commented on their own or each other's COI. STUDY DESIGN AND METHODS We conducted a systematic survey of original studies published in open access peer reviewed journals that publish their peer review reports. Using REDCap, we collected data in duplicate and independently from journals' websites and articles' peer review reports. RESULTS We included a sample of original studies (N = 144) and a second one of randomized clinical trials (N = 115) RCTs. In both samples, and for the majority of studies, reviewers reported absence of COI (70% and 66%), while substantive percentages of reviewers did not report on COI (28% and 30%) and only small percentages reported any COI (2% and 4%). For both samples, none of the editors whose names were publicly posted reported on COI. The percentages of peer reviewers commenting on the study funding, authors' COI, editors' COI, or their own COI ranged between 0 and 2% in either one of the two samples. 25% and 7% of editors respectively in the two samples commented on study funding, while none commented on authors' COI, peer reviewers' COI, or their own COI. The percentages of authors commenting in their response letters on the study funding, peer reviewers' COI, editors' COI, or their own COI ranged between 0 and 3% in either one of the two samples. CONCLUSION The percentages of peer reviewers and journals editors who addressed study funding and authors' COI and were extremely low. In addition, peer reviewers and journal editors rarely reported their own COI, or commented on their own or on each other's COI.
Collapse
Affiliation(s)
- Adham Makarem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Rayan Mroué
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Halima Makarem
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Laura Diab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bashar Hassan
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, United States of America
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - 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, Canada
| |
Collapse
|
25
|
El-Jardali F, Fadlallah R, Bou Karroum L, Akl EA. Evidence synthesis to policy: development and implementation of an impact-oriented approach from the Eastern Mediterranean Region. Health Res Policy Syst 2023; 21:40. [PMID: 37264415 DOI: 10.1186/s12961-023-00989-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Despite the importance of evidence syntheses in informing policymaking, their production and use remain limited in the Eastern Mediterranean region (EMR). There is a lack of empirical research on approaches to promote and use policy-relevant evidence syntheses to inform policymaking processes in the EMR. OBJECTIVE This study sought to describe the development of an impact-oriented approach to link evidence synthesis to policy, and its implementation through selected case studies in Lebanon, a middle-income country in the EMR. METHODS This study followed a multifaceted and iterative process that included (i) a review of the literature, (ii) input from international experts in evidence synthesis and evidence-informed health policymaking, and (iii) application in a real-world setting (implementation). We describe four selected case studies of implementation. Surveys were used to assess policy briefs, deliberative dialogues, and post-dialogue activities. Additionally, Kingdon's stream theory was adopted to further explain how and why the selected policy issues rose to the decision agenda. RESULTS The approach incorporates three interrelated phases: (1) priority setting, (2) evidence synthesis, and (3) uptake. Policy-relevant priorities are generated through formal priority setting exercises, direct requests by policymakers and stakeholders, or a focusing event. Identified priorities are translated into focused questions that can be addressed via evidence synthesis (phase 1). Next, a scoping of the literature is conducted to identify existing evidence syntheses addressing the question of interest. Unless the team identifies relevant, up-to-date and high-quality evidence syntheses, it proceeds to conducting SRs addressing the priority questions of interest (phase 2). Next, the team prepares knowledge translation products (e.g., policy briefs) for undertaking knowledge uptake activities, followed by monitoring and evaluation (phase 3). There are two prerequisites to the application of the approach: enhancing contextual awareness and capacity strengthening. The four case studies illustrate how evidence produced from the suites of activities was used to inform health policies and practices. CONCLUSIONS To our knowledge, this is the first study to describe both the development and implementation of an approach to link evidence synthesis to policy in the EMR. We believe the approach will be useful for researchers, knowledge translation platforms, governments, and funders seeking to promote evidence-informed policymaking and practice.
Collapse
Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
26
|
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. Res Involv Engagem 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
27
|
Funnell S, Jull J, Mbuagbaw L, Welch V, Dewidar O, Wang X, Lesperance M, Ghogomu E, Rizvi A, Akl EA, Avey MT, Antequera A, Bhutta ZA, Chamberlain C, Craig P, Cuervo LG, Dicko A, Ellingwood H, Feng C, Francis D, Greer-Smith R, Hardy BJ, Harwood M, Hatcher-Roberts J, Horsley T, Juando-Prats C, Kasonde M, Kennedy M, Kredo T, Krentel A, Kristjansson E, Langer L, Little J, Loder E, Magwood O, Mahande MJ, Melendez-Torres GJ, Moore A, Niba LL, Nicholls SG, Nkangu MN, Lawson DO, Obuku E, Okwen P, Pantoja T, Petkovic J, Petticrew M, Pottie K, Rader T, Ramke J, Riddle A, Shamseer L, Sharp M, Shea B, Tanuseputro P, Tugwell P, Tufte J, Von Elm E, Waddington HS, Wang H, Weeks L, Wells G, White H, Wiysonge CS, Wolfenden L, Young T. Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline. Int J Equity Health 2023; 22:55. [PMID: 36991403 PMCID: PMC10060140 DOI: 10.1186/s12939-023-01854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. METHODS We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. DISCUSSION Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.
Collapse
Affiliation(s)
- Sarah Funnell
- Department of Family Medicine, Queen's University, Kingston, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Vivian Welch
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Omar Dewidar
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
| | - Miranda Lesperance
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Elizabeth Ghogomu
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada
| | - Anita Rizvi
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - 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
| | - Marc T Avey
- Canadian Council on Animal Care, Ottawa, Canada
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, The Aga Khan University, Karachi, Pakistan
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Luis Gabriel Cuervo
- Unit of Health Services and Access, Department of Health Systems and Services, Pan American Health Organization (PAHO/WHO), Washington, DC, USA
- Doctoral School, Department of Paediatrics, Obstetrics & Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alassane Dicko
- Malaria Research and Training Center, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Holly Ellingwood
- Department of Psychology, Department of Law, Carleton University, Ottawa, ON, Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Damian Francis
- School of Health and Human Performance, Georgia College, Milledgville, USA
| | - Regina Greer-Smith
- Healthcare Research Associates, LLC/S.T.A.R. Initiative, Los Angeles, USA
| | - Billie-Jo Hardy
- Well Living House, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
- Waakebiness Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Matire Harwood
- General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Janet Hatcher-Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, Canada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Clara Juando-Prats
- Applied Health Research Center, St. Michael's Hospital, Toronto, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
| | | | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Tamara Kredo
- Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Alison Krentel
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Elizabeth Kristjansson
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Laurenz Langer
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Olivia Magwood
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Michael Johnson Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | | | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Loveline Lum Niba
- Department of Public Health, Faculty of Health Sciences, The University of Bamenda, Bamenda, Cameroon
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ekwaro Obuku
- College of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patrick Okwen
- Department of Public Health, Faculty of Health Sciences, The University of Bamenda, Bamenda, Cameroon
| | - Tomas Pantoja
- Department of Family Medicine, School of Medicine, Pontifica Universidad Católica de Chile, Santiago, Chile
| | - Jennifer Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kevin Pottie
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Tamara Rader
- Freelance Health Research Librarian, Ottawa, Canada
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Alison Riddle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Larissa Shamseer
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Melissa Sharp
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bev Shea
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Peter Tugwell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine , University of Ottawa, Ottawa, Ontario, Canada
| | | | - Erik Von Elm
- Cochrane Switzerland, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Hugh Sharma Waddington
- London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Harry Wang
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada
- Department of Medicine , University of Ottawa, Ottawa, Ontario, Canada
| | - Laura Weeks
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - George Wells
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Charles Shey Wiysonge
- Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, Durban, South Africa
| | - Luke Wolfenden
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Taryn Young
- Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
28
|
Guyatt G, Zhao Y, Mayer M, Briel M, Mustafa R, Izcovich A, Hultcrantz M, Iorio A, Alba AC, Foroutan F, Sun X, Schunemann H, DeBeer H, Akl EA, Christensen R, Schandelmaier S. GRADE Guidance 36: Updates to GRADE's approach to addressing inconsistency. J Clin Epidemiol 2023; 158:70-83. [PMID: 36898507 DOI: 10.1016/j.jclinepi.2023.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/30/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To update previous GRADE guidance addressing inconsistency and interpreting subgroup analyses. STUDY DESIGN AND SETTING Using an iterative process, we consulted with members of the GRADE working group through multiple rounds of written feedback and discussions at GRADE working group meetings. RESULTS The guidance complements previous guidance with clarification on two areas: (1) assessing inconsistency and (2) assessing the credibility of possible effect modifiers that might explain inconsistency. Specifically, the guidance clarifies that inconsistency refers to variability in results, not variability in study characteristics; that inconsistency assessment for binary outcomes requires consideration of both relative and absolute effects; how to decide between narrower and broader questions in systematic reviews and guidelines; that, with the same evidence, ratings of inconsistency may differ depending on the target of certainty rating; and how GRADE inconsistency ratings relate to a statistical measure of inconsistency I2 depending on the context in which one views results. The second part of the guidance illustrates, based on a worked example, the use of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN). The guidance explains the stepwise process of moving from a subgroup analysis to assessing the credibility of effect modification and, if found credible, to subgroup-specific effect estimates and GRADE certainty ratings. CONCLUSION This updated guidance addresses specific conceptual and practical issues that systematic review authors frequently face when considering the degree of inconsistency in estimates of treatment effects across studies.
Collapse
Affiliation(s)
- Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; Department of Medicine, McMaster University, Ontario, Canada
| | - Yunli Zhao
- The Center Centre of Gerontology and Geriatrics (National Clinical Research Center Centre for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Martin Mayer
- DynaMed Decisions, EBSCO Clinical Decisions, EBSCO, Massachusetts, USA; Open Door Clinic, Cone Health, North Carolina, USA; College of Allied Health Sciences, East Carolina University, North Carolina, USA
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Reem Mustafa
- Department of Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Ariel Izcovich
- Department of Internal Medicine, Hospital Alemán de Buenos Aires, Argentina
| | - Monica Hultcrantz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodav. 18 A, SE-171 77, Stockholm, Sweden
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; Department of Medicine, McMaster University, Ontario, Canada
| | - Ana Carolina Alba
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Holger Schunemann
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; Department of Medicine, McMaster University, Ontario, Canada
| | | | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact McMaster University, Ontario, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Stefan Schandelmaier
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University of Basel, Basel, Switzerland.
| |
Collapse
|
29
|
Raphael CK, El Hage Chehade NA, Khabsa J, Akl EA, Aouad-Maroun M, Kaddoum R. Ultrasound-guided arterial cannulation in the paediatric population. Cochrane Database Syst Rev 2023; 3:CD011364. [PMID: 36866968 PMCID: PMC9983299 DOI: 10.1002/14651858.cd011364.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND In arterial line cannulation in children and adolescents, traditional methods of locating the artery include palpation and Doppler auditory assistance. It is unclear whether ultrasound guidance is superior to these methods. This is an update of a review originally published in 2016. OBJECTIVES To evaluate the benefits and harms of ultrasound guidance compared with traditional techniques (palpation, Doppler auditory assistance) for assisting arterial line placement at all potential sites in children and adolescents. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and Web of Science from inception to 30 October 2022. We also searched four trials registers for ongoing trials, and we checked the reference lists of included studies and relevant reviews for other potentially eligible trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing ultrasound guidance versus other techniques (palpation or Doppler auditory assistance) to guide arterial line cannulation in children and adolescents (aged under 18 years). We planned to include quasi-RCTs and cluster-RCTs. For RCTs with both adult and paediatric populations, we planned to include only the paediatric population data. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of included trials and extracted data. We used standard Cochrane meta-analytical procedures, and we applied the GRADE method to assess the certainty of evidence. MAIN RESULTS We included nine RCTs reporting 748 arterial cannulations in children and adolescents (under 18 years of age) undergoing different surgical procedures. Eight RCTs compared ultrasound with palpation, and one compared ultrasound with Doppler auditory assistance. Five studies reported the incidence of haematomas. Seven involved radial artery cannulation and two involved femoral artery cannulation. The people performing arterial cannulation were physicians with different levels of experience. The risk of bias varied across studies, with some studies lacking details of allocation concealment. It was not possible to blind practitioners in any case; this adds a performance bias that is inherent to the type of intervention studied in our review. Compared to traditional methods, ultrasound guidance probably causes a large increase in first-attempt success rates (risk ratio (RR) 2.01, 95% confidence interval (CI) 1.64 to 2.46; 8 RCTs, 708 participants; moderate-certainty evidence) and probably causes a large reduction in the risk of complications such as haematoma formation (RR 0.26, 95% CI 0.14 to 0.47; 5 RCTs, 420 participants; moderate-certainty evidence). No studies reported data about ischaemic damage. Ultrasound guidance probably improves success rates within two attempts (RR 1.78, 95% CI 1.25 to 2.51; 2 RCTs, 134 participants; moderate-certainty evidence) and overall rate of successful cannulation (RR 1.32, 95% CI 1.10 to 1.59; 6 RCTs, 374 participants; moderate-certainty evidence). In addition, ultrasound guidance probably reduces the number of attempts to successful cannulation (mean difference (MD) -0.99 attempts, 95% CI -1.15 to -0.83; 5 RCTs, 368 participants; moderate-certainty evidence) and duration of the cannulation procedure (MD -98.77 seconds, 95% CI -150.02 to -47.52, 5 RCTs, 402 participants; moderate-certainty evidence). More studies are needed to confirm whether the improvement in first-attempt success rates is more pronounced in neonates and younger children compared to older children and adolescents. AUTHORS' CONCLUSIONS We identified moderate-certainty evidence that ultrasound guidance for arterial cannulation compared with palpation or Doppler auditory assistance improves first-attempt success rate, second-attempt success rate and overall success rate. We also found moderate-certainty evidence that ultrasound guidance reduces the incidence of complications, the number of attempts to successful cannulation and the duration of the cannulation procedure.
Collapse
Affiliation(s)
- Christian K Raphael
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour A El Hage Chehade
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marie Aouad-Maroun
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roland Kaddoum
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
30
|
Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, Imundo LF, Winthrop KL, Arasaratnam RJ, Baden LR, Berard R, Bridges SL, Cheah JTL, Curtis JR, Ferguson PJ, Hakkarinen I, Onel KB, Schultz G, Sivaraman V, Smith BJ, Sparks JA, Vogel TP, Williams EA, Calabrese C, Cunha JS, Fontanarosa J, Gillispie-Taylor MC, Gkrouzman E, Iyer P, Lakin KS, Legge A, Lo MS, Lockwood MM, Sadun RE, Singh N, Sullivan N, Tam H, Turgunbaev M, Turner AS, Reston J. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol 2023; 75:333-348. [PMID: 36597810 DOI: 10.1002/art.42386.10.1002/art.42386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). METHODS This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers, infectious diseases specialists, and patient representatives. Consensus required ≥70% agreement on both the direction and strength of each recommendation. RESULTS This guideline includes expanded indications for some vaccines in patients with RMDs, as well as guidance on whether to hold immunosuppressive medications or delay vaccination to maximize vaccine immunogenicity and efficacy. Safe approaches to the use of live attenuated vaccines in patients taking immunosuppressive medications are also addressed. Most recommendations are conditional and had low quality of supporting evidence. CONCLUSION Application of these recommendations should consider patients' individual risk for vaccine-preventable illness and for disease flares, particularly if immunosuppressive medications are held for vaccination. Shared decision-making with patients is encouraged in clinical settings.
Collapse
Affiliation(s)
- Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lisa F Imundo
- Columbia University Irving Medical Center, New York, New York
| | | | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lindsey R Baden
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roberta Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Karen B Onel
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joanne S Cunha
- Brown University, Brown Physicians Inc., and Providence Veterans Affairs Medical Center, East Providence, Rhode Island
| | | | | | | | - Priyanka Iyer
- University of California Irvine Medical Center, Orange
| | - Kimberly S Lakin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Alexandra Legge
- Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Herman Tam
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | |
Collapse
|
31
|
Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, Imundo LF, Winthrop KL, Arasaratnam RJ, Baden LR, Berard R, Bridges SL, Cheah JTL, Curtis JR, Ferguson PJ, Hakkarinen I, Onel KB, Schultz G, Sivaraman V, Smith BJ, Sparks JA, Vogel TP, Williams EA, Calabrese C, Cunha JS, Fontanarosa J, Gillispie-Taylor MC, Gkrouzman E, Iyer P, Lakin KS, Legge A, Lo MS, Lockwood MM, Sadun RE, Singh N, Sullivan N, Tam H, Turgunbaev M, Turner AS, Reston J. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol 2023; 75:333-348. [PMID: 36597810 DOI: 10.1002/art.42386] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). METHODS This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers, infectious diseases specialists, and patient representatives. Consensus required ≥70% agreement on both the direction and strength of each recommendation. RESULTS This guideline includes expanded indications for some vaccines in patients with RMDs, as well as guidance on whether to hold immunosuppressive medications or delay vaccination to maximize vaccine immunogenicity and efficacy. Safe approaches to the use of live attenuated vaccines in patients taking immunosuppressive medications are also addressed. Most recommendations are conditional and had low quality of supporting evidence. CONCLUSION Application of these recommendations should consider patients' individual risk for vaccine-preventable illness and for disease flares, particularly if immunosuppressive medications are held for vaccination. Shared decision-making with patients is encouraged in clinical settings.
Collapse
Affiliation(s)
- Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lisa F Imundo
- Columbia University Irving Medical Center, New York, New York
| | | | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lindsey R Baden
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roberta Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Karen B Onel
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joanne S Cunha
- Brown University, Brown Physicians Inc., and Providence Veterans Affairs Medical Center, East Providence, Rhode Island
| | | | | | | | - Priyanka Iyer
- University of California Irvine Medical Center, Orange
| | - Kimberly S Lakin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Alexandra Legge
- Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Herman Tam
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | |
Collapse
|
32
|
Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, Imundo LF, Winthrop KL, Arasaratnam RJ, Baden LR, Berard R, Bridges SL, Cheah JTL, Curtis JR, Ferguson PJ, Hakkarinen I, Onel KB, Schultz G, Sivaraman V, Smith BJ, Sparks JA, Vogel TP, Williams EA, Calabrese C, Cunha JS, Fontanarosa J, Gillispie-Taylor MC, Gkrouzman E, Iyer P, Lakin KS, Legge A, Lo MS, Lockwood MM, Sadun RE, Singh N, Sullivan N, Tam H, Turgunbaev M, Turner AS, Reston J. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Care Res (Hoboken) 2023; 75:449-464. [PMID: 36597813 DOI: 10.1002/acr.25045] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). METHODS This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers, infectious diseases specialists, and patient representatives. Consensus required ≥70% agreement on both the direction and strength of each recommendation. RESULTS This guideline includes expanded indications for some vaccines in patients with RMDs, as well as guidance on whether to hold immunosuppressive medications or delay vaccination to maximize vaccine immunogenicity and efficacy. Safe approaches to the use of live attenuated vaccines in patients taking immunosuppressive medications are also addressed. Most recommendations are conditional and had low quality of supporting evidence. CONCLUSION Application of these recommendations should consider patients' individual risk for vaccine-preventable illness and for disease flares, particularly if immunosuppressive medications are held for vaccination. Shared decision-making with patients is encouraged in clinical settings.
Collapse
Affiliation(s)
- Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lisa F Imundo
- Columbia University Irving Medical Center, New York, New York
| | | | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lindsey R Baden
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roberta Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Karen B Onel
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joanne S Cunha
- Brown University, Brown Physicians Inc., and Providence Veterans Affairs Medical Center, East Providence, Rhode Island
| | | | | | | | - Priyanka Iyer
- University of California Irvine Medical Center, Orange
| | - Kimberly S Lakin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Alexandra Legge
- Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Herman Tam
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | |
Collapse
|
33
|
Akl EA, El Khoury R, Khamis AM, El Mikati IK, Pardo-Hernandez H, Farran S, Ibrahim R, Khamis M, Hneiny L, Schunemann HJ, Kahale LA. The life and death of living systematic reviews: a methodological survey. J Clin Epidemiol 2023; 156:11-21. [PMID: 36764466 DOI: 10.1016/j.jclinepi.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES The objectives of this study are to describe the characteristics of living systematic reviews (LSRs) and to understand their life cycles. STUDY DESIGN AND SETTING We conducted a comprehensive search up to April 2021 then selected articles and abstracted data in duplicate and independently. We undertook descriptive analyses and calculated delay in version update and delay since the last published version. RESULTS We included 76 eligible LSRs with a total of 279 eligible versions. The majority of LSRs was from the clinical field (70%), was COVID-19 related (63%), and had a funding source specified (62%). The median number of versions per LSR was 2 (interquartile range (IQR) 1-4; range 1-19). The median and IQR for the ratio of the actual period of update to the planned period of update was 1.12 (0.81; 1.71). Out of all reviews with a 'planned period of update' and at least one update (N = 19), eight LSRs (42%) had a period since last published version greater than 3 times the planned period of update. No LSR included a 'retirement notice' in their latest published version. CONCLUSION While most LSR complied with the planned period of producing updates, a substantive proportion lagged since their last update.
Collapse
Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, 1280 Main Street West 2C Area, Ontario, Canada.
| | - Rayane El Khoury
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, C/Sant Quintí, Spain; CIBER Epidemiología y Salud Pública, Madrid, Av. de Monforte de Lemos, 5, 28029 Spain
| | - Sarah Farran
- Pathology and Laboratory Medicine Department, American University of Beirut Medical Center, Beirut, Riad El Solh, 1107 2020 Lebanon
| | | | - Mohamed Khamis
- Emergency Medicine Department, American University of Beirut, Beirut, Riad El Solh, 1107 2020 Lebanon
| | - Layal Hneiny
- Wegner Health Sciences Library, University of South Dakota, 1400 W 22nd St, Sioux Falls, SD 57106, USA
| | - Holger J Schunemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, 1280 Main Street West 2C Area, Ontario, Canada; MGD DeGroote Cochrane Canada and McGRADE Centers, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele (Milano), Italy; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lara A Kahale
- Cochrane Central Executive, Cochrane, London, St Albans House, 57-59, Haymarket, London SW1Y 4QX, UK
| |
Collapse
|
34
|
Khabsa J, Chang S, McKenzie JE, Barker JM, Boutron I, Kahale LA, Page MJ, Skoetz N, Akl EA. Conceptualizing the reporting of living systematic reviews. J Clin Epidemiol 2023; 156:113-118. [PMID: 36736707 DOI: 10.1016/j.jclinepi.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES As part of an effort to develop an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for living systematic reviews (LSRs), we discuss conceptual issues relevant to the reporting of LSRs and highlight a few challenges. METHODS Discussion of conceptual issues based on a scoping review of the literature and discussions among authors. RESULTS We first briefly describe aspects of the LSR production process relevant to reporting. The production cycles differ by whether the literature surveillance identifies new evidence and whether newly identified evidence is judged to be consequential. This impacts the timing, content, and format of LSR versions. Second, we discuss four types of information that are specific to the reporting of LSRs: justification for adopting the living mode, LSR specific methods, changes between LSR versions, and LSR updating status. We also discuss the challenge of conveying changes between versions to the reader. Third, we describe two commonly used reporting formats of LSRs: full and partial reports. Although partial reports are easier to produce and publish, they lead to the scattering of information across different versions. Full reports ensure the completeness of reporting. We discuss the implications for the extension of the PRISMA 2020 statement for LSRs. CONCLUSION We argue that a dynamic publication platform would facilitate complete and timely reporting of LSRs.
Collapse
Affiliation(s)
- Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Stephanie Chang
- Annals of Internal Medicine, American College of Physicians, Philadelphia, PA, USA
| | - Joanne E McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Isabelle Boutron
- Université Paris Cité, INSERM, INRAE, CNAM, CRESS, F-75004 Paris, France
| | - Lara A Kahale
- Evidence Production and Methods Directorate, Cochrane, London, UK
| | - Matthew J Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nicole Skoetz
- Department of Internal Medicine, Evidence-Based Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - 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.
| |
Collapse
|
35
|
Piggott T, Moja L, Akl EA, Lavis JN, Cooke G, Kredo T, Hogerzeil HV, Huttner B, Alonso-Coello P, Schünemann H. Decision criteria for selecting essential medicines and their connection to guidelines: an interpretive descriptive qualitative interview study. J Clin Epidemiol 2023; 154:146-155. [PMID: 36584732 DOI: 10.1016/j.jclinepi.2022.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization Model List of Essential Medicines has led to at least 137 national lists. Essential medicines should be grounded in evidence-based guideline recommendations and explicit decision criteria. Essential medicines should be available, accessible, affordable, and the supporting evidence should be accompanied by a rating of the certainty one can place in it. Our objectives were to identify criteria and considerations that should be addressed in moving from a guideline recommendation regarding a medicine to the decision of whether to add, maintain, or remove a medicine from an essential medicines list. We also seek to explore opportunities to improve organizational processes to support evidence-based health decision-making more broadly. METHODS We conducted a qualitative study with semistructured interviews of key informant stakeholders in the development and use of guidelines and essential medicine lists (EMLs). We used an interpretive descriptive analysis approach and thematic analysis of interview transcripts in NVIVO v12. RESULTS We interviewed 16 key informants working at national and global levels across all WHO regions. We identified five themes: three descriptive/explanatory themes 1) EMLs and guidelines, the same, but different; 2) EMLs can drive price reductions and improve affordability and access; 3) Time lag and disconnect between guidelines and EMLs; and two prescriptive themes 4) An "evidence pipeline" could improve coordination between guidelines and EMLs; 5) Facilitating the link between the WHO Model List of Essential Medicines (WHO EML) and national EMLs could increase alignment. CONCLUSION We found significant overlap and opportunities for alignment between guideline and essential medicine decision processes. This finding presents opportunities for guideline and EML developers to enhance strategies for collaboration. Future research should assess and evaluate these strategies in practice to support the shared goal of guidelines and EMLs: improvements in health.
Collapse
Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - John N Lavis
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; McMaster Health Forum, McMaster University, Hamilton, Canada; Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Graham Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Benedikt Huttner
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center-Servicio de Epidemiología Clínica y Salud Pública, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Medicine, McMaster University, Hamilton, Canada.
| |
Collapse
|
36
|
Piggott T, Langendam MW, Parmelli E, Adolfsson J, Akl EA, Armstrong D, Braithwaite J, Brignardello-Petersen R, Brozek J, Follmann M, Kopp I, Meerpohl JJ, Neamtiu L, Nothacker M, Qaseem A, Rossi PG, Saz-Parkinson Z, van der Wees PJ, Schünemann HJ. The GIN-McMaster guideline tool extension for the integration of quality improvement and quality assurance in guidelines: a description of the methods for its development. J Clin Epidemiol 2023; 154:197-203. [PMID: 35436527 PMCID: PMC10109085 DOI: 10.1016/j.jclinepi.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Our objective was to develop an extension of the widely used GIN-McMaster Guideline Development Checklist and Tool for the integration of quality assurance and improvement (QAI) schemes with guideline development. METHODS We used a mixed-methods approach incorporating evidence from a systematic review, an expert workshop and a survey of experts to iteratively create an extension of the checklist for QAI through three rounds of feedback. As a part of this process, we also refined criteria of a good guideline-based quality indicator. RESULTS We developed a 40-item checklist extension addressing steps for the integration of QAI into guideline development across the existing 18 topics and created one new topic specific to QAI. The steps span from 'organization, budget, planning and training', to updating of QAI and guideline implementation. CONCLUSION The tool supports integration of QAI schemes with guideline development initiatives and it will be used in the forthcoming integrated European Commission Initiative on Colorectal Cancer. Future work should evaluate this extension and QAI items requiring additional support for guideline developers and links to QAI schemes.
Collapse
Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Miranda W Langendam
- Department of Epidemiology, and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam of Public Health Research Instute, Amsterdam, The Netherlands
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Ispra, Italy.
| | - Jan Adolfsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Sweden & The Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; American University of Beirut, Beirut, Lebanon
| | - David Armstrong
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, Sydney, Australia 2109
| | | | - Jan Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Ina Kopp
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies, (AWMF-IMWi), c/o Philipps-University, Marburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies, (AWMF-IMWi), c/o Philipps-University, Marburg, Germany
| | - Amir Qaseem
- American College of Physicians, Philadelphia, PA, USA
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare and Department of Rehabilitation, The Netherlands
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Hamilton, McMaster University, Hamilton, Ontario, Canada; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milano, Italy.
| |
Collapse
|
37
|
Stewart R, Boutron I, Akl EA. The Global Evidence Commission's report provided a wake-up call for the evidence community. J Clin Epidemiol 2023; 154:212-215. [PMID: 36223815 DOI: 10.1016/j.jclinepi.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/30/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ruth Stewart
- Africa Centre for Evidence, University of Johannesburg, House 2, Research Village, Bunting Road Campus, 2006 Johannesburg, South Africa.
| | - Isabelle Boutron
- Université de Paris, INSERM, INRAE, CNAM, Centre of Research in Epidemiology and Statistics (CRESS), F-75004 Paris, France; Centre d'Épidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France; Cochrane France, F-75004 Paris, France
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI) at McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
38
|
Charide R, Stallwood L, Munan M, Sayfi S, Hartling L, Butcher NJ, Offringa M, Elliott S, Richards DP, Mathew JL, Akl EA, Kredo T, Mbuagbaw L, Motillal A, Baba A, Prebeg M, Relihan J, Scott SD, Suvada J, Falavigna M, Klugar M, Lotfi T, Stevens A, Pottie K, Schünemann HJ. Knowledge mobilization activities to support decision-making by youth, parents, and adults using a systematic and living map of evidence and recommendations on COVID-19: protocol for three randomized controlled trials and qualitative user-experience studies. Trials 2023; 24:27. [PMID: 36641457 PMCID: PMC9840541 DOI: 10.1186/s13063-023-07067-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic underlined that guidelines and recommendations must be made more accessible and more understandable to the general public to improve health outcomes. The objective of this study is to evaluate, quantify, and compare the public's understanding, usability, satisfaction, intention to implement, and preference for different ways of presenting COVID-19 health recommendations derived from the COVID-19 Living Map of Recommendations and Gateway to Contextualization (RecMap). METHODS AND ANALYSIS This is a protocol for a multi-method study. Through an online survey, we will conduct pragmatic allocation-concealed, blinded superiority randomized controlled trials (RCTs) in three populations to test alternative formats of presenting health recommendations: adults, parents, and youth, with at least 240 participants in each population. Prior to initiating the RCT, our interventions will have been refined with relevant stakeholder input. The intervention arm will receive a plain language recommendation (PLR) format while the control arm will receive the corresponding original recommendation format as originally published by the guideline organizations (standard language version). Our primary outcome is understanding, and our secondary outcomes are accessibility and usability, satisfaction, intended behavior, and preference for the recommendation formats. Each population's results will be analyzed separately. However, we are planning a meta-analysis of the results across populations. At the end of each survey, participants will be invited to participate in an optional one-on-one, virtual semi-structured interview to explore their user experience. All interviews will be transcribed and analyzed using the principles of thematic analysis and a hybrid inductive and deductive approach. ETHICS AND DISSEMINATION Through Clinical Trials Ontario, the Hamilton Integrated Research Ethics Board has reviewed and approved this protocol (Project ID: 3856). The University of Alberta has approved the parent portion of the trial (Project ID:00114894). Findings from this study will be disseminated through open-access publications in peer-reviewed journals and using social media. TRIAL REGISTRATION Clinicaltrials.gov NCT05358990 . Registered on May 3, 2022.
Collapse
Affiliation(s)
- Rana Charide
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4K1 Canada
| | - Lisa Stallwood
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada
| | - Matthew Munan
- grid.17089.370000 0001 2190 316XAlberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Shahab Sayfi
- grid.39381.300000 0004 1936 8884Schulich School of Medicine & Dentistry, Western University, London, Ontario Canada
| | - Lisa Hartling
- grid.17089.370000 0001 2190 316XAlberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada ,grid.17089.370000 0001 2190 316XCochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Nancy J. Butcher
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
| | - Martin Offringa
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada ,grid.42327.300000 0004 0473 9646Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Sarah Elliott
- grid.17089.370000 0001 2190 316XAlberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada ,grid.17089.370000 0001 2190 316XCochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Dawn P. Richards
- Five02 Labs Inc, Toronto, Ontario Canada ,grid.498672.6Canadian Arthritis Patient Alliance, Toronto, Ontario Canada
| | - Joseph L. Mathew
- grid.415131.30000 0004 1767 2903Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Elie A. Akl
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4K1 Canada ,grid.22903.3a0000 0004 1936 9801Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Tamara Kredo
- grid.415021.30000 0000 9155 0024Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa ,grid.11956.3a0000 0001 2214 904XDivision 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
| | - Lawrence Mbuagbaw
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Anesthesia, McMaster University, Hamilton, Ontario Canada ,grid.25073.330000 0004 1936 8227Department of Pediatrics, McMaster University, Hamilton, Ontario Canada ,grid.416721.70000 0001 0742 7355Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario Canada ,grid.460723.40000 0004 0647 4688Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon ,grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ashley Motillal
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4K1 Canada
| | - Ami Baba
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada
| | - Matthew Prebeg
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Jacqueline Relihan
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Shannon D. Scott
- grid.17089.370000 0001 2190 316XFaculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Jozef Suvada
- Departments of Science and International Studies, St. Elizabeth University of Public Health and Social Science, Bratislava, Slovak Republic
| | - Maicon Falavigna
- grid.8532.c0000 0001 2200 7498National Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Miloslav Klugar
- grid.10267.320000 0001 2194 0956Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Tamara Lotfi
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4K1 Canada
| | - Adrienne Stevens
- grid.415368.d0000 0001 0805 4386Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Canada
| | - Kevin Pottie
- grid.39381.300000 0004 1936 8884Schulich School of Medicine & Dentistry, Western University, London, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Family Medicine, Western University, London, Ontario Canada
| | - Holger J. Schünemann
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4K1 Canada ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
39
|
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. [The PRISMA 2020 statement: an updated guideline for reporting systematic reviewsDeclaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas]. Rev Panam Salud Publica 2022; 46:e112. [PMID: 36601438 PMCID: PMC9798848 DOI: 10.26633/rpsp.2022.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/30/2022] Open
Abstract
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
Collapse
Affiliation(s)
- Matthew J. Page
- Monash UniversitySchool of Public Health and Preventive MedicineMelbourneAustráliaMonash University, School of Public Health and Preventive Medicine, Melbourne, Austrália,Matthew J Page,
| | - Joanne E. McKenzie
- Monash UniversitySchool of Public Health and Preventive MedicineMelbourneAustráliaMonash University, School of Public Health and Preventive Medicine, Melbourne, Austrália
| | - Patrick M. Bossuyt
- University of AmsterdamAmsterdam University Medical CentresAmsterdãHolandaUniversity of Amsterdam, Amsterdam University Medical Centres, Amsterdã, Holanda.
| | - Isabelle Boutron
- Université de ParisCentre of Epidemiology and StatisticsParisFrançaUniversité de Paris, Centre of Epidemiology and Statistics, Paris, França
| | - Tammy C. Hoffmann
- Bond UniversityFaculty of Health Sciences and MedicineGold CoastAustráliaBond University, Faculty of Health Sciences and Medicine, Gold Coast, Austrália
| | - Cynthia D. Mulrow
- University of Texas Health Science Center at San AntonioSan AntonioTexasEstados UnidosUniversity of Texas Health Science Center at San Antonio, San Antonio, Texas, Estados Unidos
| | - Larissa Shamseer
- University of OttawaSchool of Epidemiology and Public HealthOttawaCanadáUniversity of Ottawa, School of Epidemiology and Public Health, Ottawa, Canadá
| | | | - Elie A. Akl
- American University of BeirutClinical Research InstituteBeiruteLíbanoAmerican University of Beirut, Clinical Research Institute, Beirute, Líbano
| | - Sue E. Brennan
- Monash UniversitySchool of Public Health and Preventive MedicineMelbourneAustráliaMonash University, School of Public Health and Preventive Medicine, Melbourne, Austrália
| | - Roger Chou
- Oregon Health & Science UniversityDepartment of Medical Informatics and Clinical EpidemiologyPortlandOregonEstados UnidosOregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon, Estados Unidos
| | - Julie Glanville
- University of YorkYork Health Economics ConsortiumYorkReino UnidoUniversity of York, York Health Economics Consortium, York, Reino Unido
| | - Jeremy M. Grimshaw
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramOttawaCanadáOttawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canadá
| | - Asbjørn Hróbjartsson
- University of Southern DenmarkDepartment of Clinical ResearchOdenseDinamarcaUniversity of Southern Denmark, Department of Clinical Research, Odense, Dinamarca
| | - Manoj M. Lalu
- Ottawa HospitalDepartment of Anesthesiology and Pain MedicineOttawaCanadáOttawa Hospital, Department of Anesthesiology and Pain Medicine, Ottawa, Canadá
| | - Tianjing Li
- University of Colorado DenverSchool of MedicineDenverCloradoUnited StatesUniversity of Colorado Denver, School of Medicine, Denver, Colorado, United States
| | - Elizabeth W. Loder
- Harvard Medical SchoolBrigham and Women’s HospitalBostonMassachusettsEstados UnidosHarvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, Estados Unidos
| | - Evan Mayo-Wilson
- Indiana University School of Public Health-BloomingtonDepartment of Epidemiology and BiostatisticsBloomingtonIndianaEstados UnidosIndiana University School of Public Health-Bloomington, Department of Epidemiology and Biostatistics, Bloomington, Indiana, Estados Unidos
| | - Steve McDonald
- Monash UniversitySchool of Public Health and Preventive MedicineMelbourneAustráliaMonash University, School of Public Health and Preventive Medicine, Melbourne, Austrália
| | - Luke A. McGuinness
- University of BristolBristol Medical SchoolBristolReino UnidoUniversity of Bristol, Bristol Medical School, Bristol, Reino Unido
| | - Lesley A. Stewart
- University of YorkCentre for Reviews and DisseminationYorkReino UnidoUniversity of York, Centre for Reviews and Dissemination, York, Reino Unido
| | - James Thomas
- University College LondonSocial Research InstituteLondonReino UnidoUniversity College London, Social Research Institute, London, Reino Unido
| | - Andrea C. Tricco
- University of TorontoInstitute of Health Management, Policy, and EvaluationTorontoCanadáUniversity of Toronto, Institute of Health Management, Policy, and Evaluation, Toronto, Canadá
| | - Vivian A. Welch
- Bruyère Research InstituteMethods CentreOttawaOntarioCanadáBruyère Research Institute, Methods Centre, Ottawa, Ontario, Canadá
| | - Penny Whiting
- University of BristolBristol Medical SchoolBristolReino UnidoUniversity of Bristol, Bristol Medical School, Bristol, Reino Unido
| | - David Moher
- Ottawa Hospital Research Institutecentre for JournalologyOttawaCanadáOttawa Hospital Research Institute, centre for Journalology, Ottawa, Canadá
| |
Collapse
|
40
|
Kabbani D, Sonpar A, Weyant B, Lau KCK, Robbins M, Campbell S, Doucette K, Abraldes JG, Lotfi T, Chaktoura M, Akl EA, Cervera C. Immune-Based Therapy for Hospitalized Patients With COVID-19 and Risk of Secondary Infections: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 10:ofac655. [PMID: 36628058 PMCID: PMC9825199 DOI: 10.1093/ofid/ofac655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background Immune-based therapies are standard-of-care treatment for coronavirus disease 2019 (COVID-19) patients requiring hospitalization. However, safety concerns related to the potential risk of secondary infections may limit their use. Methods We searched OVID Medline, Ovid EMBASE, SCOPUS, Cochrane Library, clinicaltrials.gov, and PROSPERO in October 2020 and updated the search in November 2021. We included randomized controlled trials (RCTs). Pairs of reviewers screened abstracts and full studies and extracted data in an independent manner. We used RevMan to conduct a meta-analysis using random-effects models to calculate the pooled risk ratio (RR) and 95% CI for the incidence of infection. Statistical heterogeneity was determined using the I 2 statistic. We assessed risk of bias for all studies and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. We conducted a meta-regression using the R package to meta-explore whether age, sex, and invasive mechanical ventilation modified risk of infection with immune-based therapies. The protocol is registered with PROSPERO (CRD42021229406). Results This was a meta-analysis of 37 RCTs including 32 621 participants (mean age, 60 years; 64% male). The use of immune-based therapy for COVID-19 conferred mild protection for the occurrence of secondary infections (711/15 721, 4.5%, vs 616/16 900, 3.6%; RR, 0.82; 95% CI, 0.71-0.95; P = .008; I 2 = 28%). A subgroup analysis did not identify any subgroup effect by type of immune-based therapies (P = .85). A meta-regression revealed no impact of age, sex, or mechanical ventilation on the effect of immune-based therapies on risk of infection. Conclusions We identified moderate-certainty evidence that the use of immune-based therapies in COVID-19 requiring hospitalization does not increase the risk of secondary infections.
Collapse
Affiliation(s)
- Dima Kabbani
- Correspondence: Dima Kabbani, MD, MSc, Division of Infectious Diseases. University of Alberta, 124 Clinical Sciences Building, 11350 83 Avenue, Edmonton AB T6G 2G3, Canada ()
| | - Ashlesha Sonpar
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Benson Weyant
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Keith C K Lau
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Robbins
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Karen Doucette
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Juan G Abraldes
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Marlene Chaktoura
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - 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
|
41
|
Dewidar O, Lotfi T, Langendam M, Parmelli E, Saz Parkinson Z, Solo K, Chu DK, Mathew JL, Akl EA, Brignardello-Petersen R, Mustafa RA, Moja L, Iorio A, Chi Y, Canelo-Aybar C, Kredo T, Karpusheff J, Turgeon AF, Alonso-Coello P, Wiercioch W, Gerritsen A, Klugar M, Rojas MX, Tugwell P, Welch VA, Pottie K, Munn Z, Nieuwlaat R, Ford N, Stevens A, Khabsa J, Nasir Z, Leontiadis GI, Meerpohl JJ, Piggott T, Qaseem A, Matthews M, Schünemann HJ. Which actionable statements qualify as good practice statements In Covid-19 guidelines? A systematic appraisal. BMJ Evid Based Med 2022; 27:361-369. [PMID: 35428695 PMCID: PMC9044517 DOI: 10.1136/bmjebm-2021-111866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the development and quality of actionable statements that qualify as good practice statements (GPS) reported in COVID-19 guidelines. DESIGN AND SETTING Systematic review . We searched MEDLINE, MedSci, China National Knowledge Infrastructure (CNKI), databases of Grading of Recommendations Assessment, Development and Evaluation (GRADE) Guidelines, NICE, WHO and Guidelines International Network (GIN) from March 2020 to September 2021. We included original or adapted recommendations addressing any COVID-19 topic. MAIN OUTCOME MEASURES We used GRADE Working Group criteria for assessing the appropriateness of issuing a GPS: (1) clear and actionable; (2) rationale necessitating the message for healthcare practice; (3) practicality of systematically searching for evidence; (4) likely net positive consequences from implementing the GPS and (5) clear link to the indirect evidence. We assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS 253 guidelines from 44 professional societies issued 3726 actionable statements. We classified 2375 (64%) as GPS; of which 27 (1%) were labelled as GPS by guideline developers. 5 (19%) were labelled as GPS by their authors but did not meet GPS criteria. Of the 2375 GPS, 85% were clear and actionable; 59% provided a rationale necessitating the message for healthcare practice, 24% reported the net positive consequences from implementing the GPS. Systematic collection of evidence was deemed impractical for 13% of the GPS, and 39% explained the chain of indirect evidence supporting GPS development. 173/2375 (7.3%) statements explicitly satisfied all five criteria. The guidelines' overall quality was poor regardless of the appropriateness of GPS development and labelling. CONCLUSIONS Statements that qualify as GPS are common in COVID-19 guidelines but are characterised by unclear designation and development processes, and methodological weaknesses.
Collapse
Affiliation(s)
- Omar Dewidar
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Miranda Langendam
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Elena Parmelli
- Joint Research Centre, European Commission, Ispra, Italy
| | - Zuleika Saz Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Internal Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneve, Switzerland
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Clinical Pharmacology, Department of Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Alexis F Turgeon
- Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec (CHA), CHA-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Annette Gerritsen
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - María Ximena Rojas
- Department of Clinical Epidemiology and Public Health, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Peter Tugwell
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vivian Andrea Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Pottie
- Deparatment of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary Munn
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nathan Ford
- Department of HIV, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland
| | - Adrienne Stevens
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Zil Nasir
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Grigorios I Leontiadis
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joerg J Meerpohl
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
- Medical Center - University of Freiburg, Institute for Evidence in Medicine, Freiburg, Germany
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Micayla Matthews
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Cochrane Canada, Hamilton, Ontario, Canada
| |
Collapse
|
42
|
Chakhtoura M, Karam E, Akl EA, El Rassi R, Honein-AbouHaidar G. Research fellowship in a Lebanese academic medical center: What does it take to shift from an informal to a formal program? PLoS One 2022; 17:e0278576. [PMID: 36455060 PMCID: PMC9714842 DOI: 10.1371/journal.pone.0278576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Research fellowship programs help medical graduates acquire research skills for an academic career. While our institution employed a large number of research fellows, it did not offer them a formal training program. This study aimed to assess the views of fellows and their mentors regarding the current research fellowship program, and to seek their suggestions for a formal training program at our medical center. We conducted a qualitative descriptive study using both focus group discussions and individual interviews with research fellows, and individual interviews with their mentors. We recruited all eligible participants by email. We collected data in person and analyzed it thematically. We followed the consolidated criteria for reporting of qualitative research (COREQ) checklist. A total of 17 research fellows and 17 mentors participated in the study. Participants described the current non-formal program and proposed suggestions for a formal training program. The identification of available vacant positions and the recruitment process followed an unstructured approach, through networking with mentors and previous fellows. Although there is a formal contract, there is no job description, and no definition of roles, responsibilities and rights. Some fellows get the opportunity of being involved in all aspects of research and benefit from a favorable mentor-mentee relationship. Conversely, others struggle with authorship and with the projects allocated to them, some being "non-research" related. Not all fellows end up publishing their projects. Participants provided suggestions to shift into a formal training, including measures to improve on the recruitment process of fellows, defining roles and exposure to all aspects of research. Research fellows are eager to learn, but the currently available program is unstructured. They need a formal training program that meets their expectations, one that offers equitable learning opportunities and benefits to all.
Collapse
Affiliation(s)
- Marlene Chakhtoura
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elsa Karam
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie A. Akl
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola El Rassi
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | |
Collapse
|
43
|
Schünemann HJ, Brennan S, Davoli M, Mustafa RA, Akl EA, Meerpohl JJ, Flottorp S, Rojas MX, Guyatt G, Langendam M, Alonso Coello P, Dahm P. Strong and high-quality evidence synthesis needs Cochrane: a statement of support by the GRADE Guidance Group. J Clin Epidemiol 2022; 152:285-287. [PMID: 36223813 DOI: 10.1016/j.jclinepi.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/02/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada; Michael G. DeGroote, Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marina Davoli
- Department of Epidemiology Lazio Region, Via Cristoforo Colombo 112, 00147
| | - Reem A Mustafa
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut Medical Center, P.O.Box 11-0236/CRI (E15), Riad-El-Solh, Beirut 1107 2020, Lebanon
| | - Joerg J Meerpohl
- Michael G. DeGroote, Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Signe Flottorp
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Ximena Rojas
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona 08025, Spain
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miranda Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health institute, Amsterdam, The Netherlands
| | - Pablo Alonso Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona 08025, Spain
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
44
|
Omair MA, Al Rayes H, Khabsa J, Yaacoub S, Abdulaziz S, Al Janobi GA, Al Khalaf A, Al Mehmadi B, Al Nassar M, AlBalawi F, AlFurayj AS, Al-Jedai AH, Almalag HM, Almudaiheem HY, AlRehaily A, Attar MA, El Kibbi L, Halabi H, Hasan M, Singh JA, Fraenkel L, Akl EA. Recommendations for the treatment of rheumatoid arthritis in Saudi Arabia: adolopment of the 2021 American College of Rheumatology guidelines. BMC Rheumatol 2022; 6:70. [PMID: 36414983 PMCID: PMC9682746 DOI: 10.1186/s41927-022-00301-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 2021 American College of Rheumatology (ACR) rheumatoid arthritis (RA) guideline considers the specific context of the United States which differs from that of Saudi Arabia in many aspects that may impact recommendations. The objective of this project was to adapt a set of prioritized recommendations from the 2021 ACR guideline for the treatment of rheumatoid arthritis RA for the context of Saudi Arabia, by the Saudi Society for Rheumatology (SSR). METHODS The process followed the GRADE-ADOLOPMENT methodology, and the reporting adhered to the RIGHT-Ad@pt checklist. Working groups included a coordination group and a 19-member panel representing different stakeholder groups. The Evidence to Decision (EtD) tables included evidence on health effects from the source guideline and contextual information from the Saudi setting. RESULTS The panel prioritized and adapted five recommendations from the source guideline. The process led to modifying two out of the five prioritized recommendations, all listed here. In naive patients with low disease activity, methotrexate (MTX) is conditionally recommended over sulfasalazine (SSZ) (modified direction); hydroxychloroquine (HCQ) is conditionally recommended over SSZ (unmodified). Initiation of csDMARDs with short-term glucocorticoids is conditionally recommended over csDMARDs alone in naive patients with moderate to high disease activity (modified direction). Switch to subcutaneous MTX is conditionally recommended over addition/switch to alternative DMARD(s) in patients taking oral MTX who are not at target (unmodified). Discontinuation of MTX is conditionally recommended over gradual discontinuation of the bDMARD or tsDMARD for patients taking MTX plus a bDMARD or tsDMARD who wish to discontinue a DMARD (unmodified). CONCLUSION Rheumatologists practicing in Saudi Arabia can use the adoloped recommendations generated by this project while adopting the rest of the recommendations from the 2021 ACR guidelines.
Collapse
Affiliation(s)
- Mohammed A. Omair
- grid.56302.320000 0004 1773 5396Rheumatology Unit, Department of Medicine, King Saud University, PO Box 2925, Riyadh, 11461 Saudi Arabia
| | - Hanan Al Rayes
- grid.415989.80000 0000 9759 8141Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Joanne Khabsa
- grid.411654.30000 0004 0581 3406AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- grid.411654.30000 0004 0581 3406Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Yaacoub
- grid.411654.30000 0004 0581 3406AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- grid.411654.30000 0004 0581 3406Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sultana Abdulaziz
- grid.415296.d0000 0004 0607 1539Division of Rheumatology, Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Ghada A. Al Janobi
- grid.415458.90000 0004 1790 6706Rheumatology Unit, Department of Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Abdulaziz Al Khalaf
- grid.56302.320000 0004 1773 5396Rheumatology Unit, Department of Medicine, King Saud University, PO Box 2925, Riyadh, 11461 Saudi Arabia
| | - Bader Al Mehmadi
- grid.449051.d0000 0004 0441 5633Division of Rheumatology, Department of Medicine, College of Medicine, Majmaah University, Al-Majmaah, 11952 Saudi Arabia
| | - Mahasin Al Nassar
- grid.56302.320000 0004 1773 5396Department of Obstetrics and Gynecology, King Saud University, Riyadh, Saudi Arabia
| | - Faisal AlBalawi
- grid.415277.20000 0004 0593 1832Section of Rheumatology, Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah S. AlFurayj
- Rheumatology Unit, Department of Medicine, Buraidah Central Hospital, B.C.H, Buraidah, Qassim Saudi Arabia
| | - Ahmed Hamdan Al-Jedai
- grid.415696.90000 0004 0573 9824Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- grid.411335.10000 0004 1758 7207College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haya Mohammed Almalag
- grid.56302.320000 0004 1773 5396Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hajer Yousef Almudaiheem
- grid.415696.90000 0004 0573 9824Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Ali AlRehaily
- grid.415462.00000 0004 0607 3614Department of Medicine, Section of Rheumatology, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Mohammed A. Attar
- grid.413494.f0000 0004 0490 2749Division of Rheumatology, Department of Medicine, Al Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Hussein Halabi
- grid.415310.20000 0001 2191 4301Section of Rheumatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center-Jeddah, Jeddah, Saudi Arabia
| | - Manal Hasan
- grid.411975.f0000 0004 0607 035XDivision of Rheumatology, Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jasvinder A. Singh
- grid.280808.a0000 0004 0419 1326Medicine Service, VA Medical Center, 700 19th St S, Birmingham, AL 35233 USA
- grid.265892.20000000106344187Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 510 20th Street S, Birmingham, AL 35294-0022 USA
- grid.265892.20000000106344187Department of Epidemiology at the UAB School of Public Health, Ryals Public Health Building, 1665 University Blvd, Birmingham, AL 35294-0022 USA
| | - Liana Fraenkel
- grid.414445.4Berkshire Medical Center, Pittsfield, MA USA
- grid.47100.320000000419368710Yale University School of Medicine, New Haven, CT USA
| | - Elie A. Akl
- grid.22903.3a0000 0004 1936 9801Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON Canada
| |
Collapse
|
45
|
Salloum RG, LeLaurin JH, Nakkash R, Akl EA, Parascandola M, Ricciardone MD, Elbejjani M, Kabakian-Khasholian T, Lee JH, El-Jardali F, Shelley D, Vinson C. Developing Capacity in Dissemination and Implementation Research in the Eastern Mediterranean Region: Evaluation of a Training Workshop. Glob Implement Res Appl 2022; 2:340-349. [PMID: 36407476 PMCID: PMC9660112 DOI: 10.1007/s43477-022-00067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/29/2022] [Indexed: 11/15/2022]
Abstract
As the demand for dissemination and implementation (D&I) research grows globally, there is a need for D&I capacity building in regions where D&I science is underrepresented. The Workshop on Dissemination and Implementation Research in Health (WONDIRH) was aimed for participants in the Eastern Mediterranean region to (1) appreciate the complex process of bridging research and practice in a variety of real-world settings, and (2) develop research that balances rigor with relevance and employs study designs and methods appropriate for the complex processes involved in D&I. The present exploratory study investigates participants' satisfaction with the workshop, the enhancement of their self-rated confidence in D&I skills, as well as their intention to apply the learned content into practice. The workshop included four weekly 90-min virtual interactive training sessions in conjunction with open access content from the National Cancer Institute Training Institute in Implementation and Dissemination Research in Cancer (TIDIRC). We applied a one-group pre-post design for the evaluation of workshop. Participants were invited to self-rate their confidence in D&I competencies (15 items, pre and post workshop). At the end of the workshop, participants additionally were asked to rate their satisfaction (5 items, 1-5 scales), and their intention to apply the learned content into practice (4 items, 1-5 scales). Of the 77 workshop participants, 34 completed the evaluation. Confidence improved between pre- and post-workshop assessments in all 15 self-rated D&I competencies. Respondents were generally satisfied with the workshop (mean satisfaction range 3.82-4.26 across the 5 items) and endorsed intentions to apply workshop topics (mean intention range 4.03-4.35 across the 4 items). This initial workshop demonstrated the ability to attract and engage participants to enhance their confidence in D&I research competencies and skills and to build capacity in D&I research. Future efforts should consider offering targeted training for researchers at different stages and to clearly articulate learning objectives. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00067-y.
Collapse
Affiliation(s)
- Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL USA
- American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Jennifer H. LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL USA
| | - Rima Nakkash
- American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
- College of Health and Health Services, George Mason University, Fairfax, VA USA
| | - Elie A. Akl
- American University of Beirut Faculty of Medicine, Beirut, Lebanon
- McMaster University Medical Centre, Hamilton, ON Canada
| | | | | | | | | | - Ji-Hyun Lee
- University of Florida Health Cancer Center, Gainesville, FL USA
| | - Fadi El-Jardali
- American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | | | | |
Collapse
|
46
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
47
|
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: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
48
|
Khabsa J, Jain S, El-Harakeh A, Rizkallah C, Pandey DK, Manaye N, Honein-AbouHaidar G, Halleux C, Dagne DA, Akl EA. Stakeholders’ views and perspectives on treatments of visceral leishmaniasis and their outcomes in HIV-coinfected patients in East Africa and South-East Asia: A mixed methods study. PLoS Negl Trop Dis 2022; 16:e0010624. [PMID: 35969636 PMCID: PMC9410553 DOI: 10.1371/journal.pntd.0010624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 08/25/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background In visceral leishmaniasis (VL) patients coinfected with human immunodeficiency virus (HIV), combination therapy (liposomal amphotericin B infusion and oral miltefosine) is being considered as an alternative to liposomal amphotericin B monotherapy. We aimed to assess the views of stakeholders in relation to these treatment options. Methodology In a mixed methods study, we surveyed and interviewed patients, government functionaries, programme managers, health service providers, nongovernmental organizations, researchers, and World Health Organization (WHO) personnel. We used the Evidence to Decision (EtD) framework for data collection planning and analysis. Constructs of interest included valuation of outcomes, impact on equity, feasibility and acceptability of the treatment options, implementation considerations, monitoring and evaluation, and research priorities. Principal findings/Conclusion Mortality and non-serious adverse events were rated as “critical” by respectively the highest (61%) and lowest percentages (47%) of survey participants. Participants viewed clinical cure as essential for patients to regain productivity. Non-patient stakeholders emphasized the importance of “sustained” clinical cure. For most survey participants, combination therapy, compared with monotherapy, would increase health equity (40%), and be more acceptable (79%) and feasible (57%). Interviews revealed that combination therapy was more feasible and acceptable than monotherapy when associated with a shorter duration of hospitalization. The findings of the interviews provided insight into those of the survey. When choosing between alternative options, providers should consider the outcomes that matter to patients as well as the impact on equity, feasibility, and acceptability of the options. In East Africa and South Asia, the number of patients with visceral leishmaniasis (VL) co-infected with human immunodeficiency virus (HIV) has been increasing over the years. In addition to independently posing major health challenges, the two conditions have detrimental effects on each other. In light of new evidence on treatment regimens for this patient population, the World Health Organization (WHO) recently updated its evidence-based region-specific treatment recommendations. To inform this process, we assessed the views of stakeholders on the outcomes of interest and on medication treatment options. The mixed methods study consisted of an online survey and semi-structured interviews. Outcomes such as mortality, complications, clinical cure, relapse and serious adverse events were viewed as important because of the burden associated with their experience, their consequences, and the co-infection status of the patients. Outcomes such as non-serious adverse events were viewed as less important for reasons relating to patient tolerability and ease of treatment. As compared to monotherapy, combination therapy was found to be more equitable, acceptable, and feasible. While our findings are important to consider by clinicians treating patients with VL patients coinfected with HIV, they also inform decisions made by other stakeholders such as guideline developers and program managers.
Collapse
Affiliation(s)
- Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saurabh Jain
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Amena El-Harakeh
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cynthia Rizkallah
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Dhruv K. Pandey
- Kala-azar Elimination Programme, World Health Organization Country Office, New Delhi, India
| | - Nigus Manaye
- Neglected Tropical Diseases, World Health Organization Country Office, Addis Ababa, Ethiopia
| | | | - Christine Halleux
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| |
Collapse
|
49
|
Zeng L, Brignardello-Petersen R, Hultcrantz M, Mustafa RA, Murad MH, Iorio A, Traversy G, Akl EA, Mayer M, Schünemann HJ, Guyatt GH. GRADE Guidelines 34: Updated GRADE guidance for imprecision rating using a minimally contextualized approach. J Clin Epidemiol 2022; 150:216-224. [DOI: 10.1016/j.jclinepi.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/01/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
|
50
|
El Mikati IK, Khabsa J, Harb T, Khamis M, Agarwal A, Pardo-Hernandez H, Farran S, Khamis AM, El Zein O, El-Khoury R, Schünemann HJ, Akl EA, Alonso-Coello P, Alper BS, Amer YS, Arayssi T, Barker JM, Bouakl I, Boutron I, Brignardello-Petersen R, Carandang K, Chang S, Chen Y, Cuker A, El-Jardali F, Florez I, Ford N, Grove J, Guyatt GH, Hazlewood GS, Kredo T, Lamontagne F, Langendam MW, Lewin S, Macdonald H, McFarlane E, Meerpohl J, Munn Z, Murad MH, Mustafa RA, Neumann I, Nieuwlaat R, Nowak A, Pardo JP, Qaseem A, Rada G, Righini M, Rochwerg B, Rojas-Reyes MX, Siegal D, Siemieniuk R, Singh JA, Skoetz N, Sultan S, Synnot A, Tugwell P, Turner A, Turner T, Venkatachalam S, Welch V, Wiercioch W. A Framework for the Development of Living Practice Guidelines in Health Care. Ann Intern Med 2022; 175:1154-1160. [PMID: 35785533 DOI: 10.7326/m22-0514] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Living practice guidelines are increasingly being used to ensure that recommendations are responsive to rapidly emerging evidence. OBJECTIVE To develop a framework that characterizes the processes of development of living practice guidelines in health care. DESIGN First, 3 background reviews were conducted: a scoping review of methods papers, a review of handbooks of guideline-producing organizations, and an analytic review of selected living practice guidelines. Second, the core team drafted the first version of the framework. Finally, the core team refined the framework through an online survey and online discussions with a multidisciplinary international group of stakeholders. SETTING International. PARTICIPANTS Multidisciplinary group of 51 persons who have experience with guidelines. MEASUREMENTS Not applicable. RESULTS A major principle of the framework is that the unit of update in a living guideline is the individual recommendation. In addition to providing definitions, the framework addresses several processes. The planning process should address the organization's adoption of the living methodology as well as each specific guideline project. The production process consists of initiation, maintenance, and retirement phases. The reporting should cover the evidence surveillance time stamp, the outcome of reassessment of the body of evidence (when applicable), and the outcome of revisiting a recommendation (when applicable). The dissemination process may necessitate the use of different venues, including one for formal publication. LIMITATION This study does not provide detailed or practical guidance for how the described concepts would be best implemented. CONCLUSION The framework will help guideline developers in planning, producing, reporting, and disseminating living guideline projects. It will also help research methodologists study the processes of living guidelines. PRIMARY FUNDING SOURCE None.
Collapse
Affiliation(s)
- Ibrahim K El Mikati
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon (I.K.M., J.K.)
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon (I.K.M., J.K.)
| | - Tarek Harb
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon (T.H.)
| | - Mohamed Khamis
- Emergency Medicine Department, American University of Beirut, Beirut, Lebanon (M.K.)
| | - Arnav Agarwal
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada, and MAGIC Evidence Ecosystem Foundation, Oslo, Norway (A.A.)
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, and CIBER Epidemiología y Salud Pública, Madrid, Spain (H.P.)
| | - Sarah Farran
- Clinical Pathology Department, American University of Beirut, Beirut, Lebanon (S.F.)
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom (A.M.K.)
| | - Ola El Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon (O.E.)
| | - Rayane El-Khoury
- Infectious Disease Epidemiology Group and World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar (R.E.)
| | - Holger J Schünemann
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (H.J.S.)
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (E.A.A.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|