Publications by authors named "Elie A Akl"

Data on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate.

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Importance: Observational studies can provide valuable insights to inform decisions on health equity. Existing guidelines for reporting such studies, such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, currently lack specific considerations for reporting on health equity. Health equity is defined as the absence of avoidable and unfair differences that may exist across individuals and populations due to structural and systematic inequities in living and working conditions, opportunities, and resources.

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Objectives: Living systematic reviews (LSRs) are an emerging type of review that continuously updates as new evidence becomes available. A previous methodological survey conducted in 2021 identified and studied all health-based LSRs. Since then, the landscape has changed, including the on-going accumulation of COVID-19 research and availability of automation tools.

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Background: Many outcomes relevant to rheumatoid arthritis are measured as continuous variables. Judging whether the results of those measurements are clinically significant requires determining the minimal important difference (MID) estimate. Therefore, valid MID estimate(s) are essential for the purposes of clinical decision-making and developing clinical recommendations.

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In 2017, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group defined the certainty of evidence as the certainty that the true effect lies on one side of a threshold or in a particular range. This definition has proved useful as the basis for rating certainty, facilitating the interpretation of the results for the target audience. However, the categorization of suggested thresholds and ranges as levels of contextualization led to inconsistencies between the initial and subsequent papers and has proved confusing for some GRADE users.

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Background: Given the colonial connotations of the term "stakeholder", its continued use may be perceived as disrespectful to Indigenous Peoples. While several groups have introduced alternative terms, each has its own limitations. The objective of this article is to introduce "interest-holders" as an alternative term to "stakeholders" and describe the discussions underpinning the adoption of the new term by the MuSE Consortium.

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Objectives: Recently, we published a reporting checklist for conflicts of interest (COI) and funding in practice guidelines and guideline organizations' policy documents, RIGHT for Conflicts of Interest and Funding (RIGHT-COI&F). In this study, we examined the reliability and usability of this new tool in practice to assess reporting.

Study Design And Setting: We extracted a sample of guideline development organizations' COI and funding policies, and all guidelines developed by the World Health Organization (WHO) since 2019.

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Background: Practice guidelines may reduce health inequities by addressing preventable and unjust differences in health. However, health equity considerations are often inadequately integrated into the guideline planning and development process. This article describes a pragmatic approach to enhancing health equity considerations within guidelines by introducing an extension to the GIN-McMaster Guideline Development Checklist (GDC).

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Description: The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients seeking this therapy.

Methods: The PHMSC considers areas where evidence is uncertain or emerging or practice does not follow the evidence to provide clinical advice based on a review and assessment of scientific work, including systematic reviews and individual studies. Sources of evidence included a living systematic review on cannabis and cannabinoid treatments for chronic noncancer pain and a series of living systematic reviews and primary studies.

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Background And Objectives: Health equity aims to provide all individuals with equal and fair opportunities to achieve optimal health. Practice guidelines can play a pivotal role in advancing health equity; yet, few organizations use tools to systematically integrate health equity considerations. Thus, it is important to establish a foundation for practical tools to support the systematic integration of health equity considerations.

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Objectives: This study aimed to explore institutional conflicts of interest (COIs) in volume-outcome studies investigating whether higher hospital volume is associated with better patient outcomes.

Study Design And Setting: We used a sample of studies (n = 68) included in a systematic review on the hospital volume-outcome relationship in total knee arthroplasty. For studies in which at least one of the study authors was affiliated with a hospital, we contacted the study authors by email to obtain their institutional volume and to survey them about their opinion on institutional COIs.

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Objectives: Better engagement of diverse groups of interest-holders in the development of health guidelines has been proposed to improve their usefulness, implementability, and acceptability. Guidelines shape clinical or public health practice decision-making. Trustworthy guidelines are systematically developed documents that include actionable statements based on evidence and a formal, structured and transparent decision process.

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Description: Artificial intelligence (AI) has been defined by the High-Level Expert Group on AI of the European Commission as "systems that display intelligent behaviour by analysing their environment and taking actions-with some degree of autonomy-to achieve specific goals." Artificial intelligence has the potential to support guideline planning, development and adaptation, reporting, implementation, impact evaluation, certification, and appraisal of recommendations, which we will refer to as "guideline enterprise." Considering this potential, as well as the lack of guidance for the use of AI in guidelines, the Guidelines International Network (GIN) proposes a set of principles for the development and use of AI tools or processes to support the health guideline enterprise.

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Objectives: To describe the processes of reconciling overlapping guidance and prioritizing practice questions for a World Health Organization (WHO) guideline on Infection Prevention and Control for Ebola and Marburg disease.

Methods: This work involved the reconciliation of guidance, the generation of potential practice questions, and the prioritization of those questions. Contributors included the WHO secretariat, the WHO steering group, the guideline methodologists, and the guideline development group (GDG).

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Background And Objective: GRADE and other evidence to decision (EtD) frameworks are widely used by guideline development groups (GDG) and other decision-makers. When GDGs judge the magnitude of desirable and undesirable health outcomes on EtDs, they typically categorize them as trivial, small, moderate, or large. However, generic judgment or decision thresholds (DTs) that could guide the user about such estimates of effect size or serve as references for interpretation of findings are not yet available.

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Background: Health guideline developers engage with interested people and groups to ensure that guidelines and their recommendations are relevant and useful to those who will be affected by them. These 'interest-holders' include patients, payers/purchasers of health services, payers of health research, peer review editors, product makers, programme managers, policymakers, providers, principal investigators, and the public. The Guidelines International Network (GIN) and McMaster University Guideline Development Checklist describes 146 steps of the guideline process organized into 18 topics.

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Publications of living systematic reviews (LSRs) are increasing rapidly. Guidance facilitating transparent, complete, and accurate reporting of LSRs is needed. This paper reports the development of an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for LSRs (PRISMA-LSR).

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Background: COVID-19-related critical and acute illness is associated with an increased risk of venous thromboembolism (VTE). These evidence-based recommendations of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about using anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness; patients with COVID-19-related acute illness; and those being discharged from the hospital, who do not have suspected or confirmed VTE.

Methods: ASH formed a multidisciplinary panel, including patient representatives.

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This is the protocol for a Campbell systematic review. The objectives are as follows. The objective of this review is to identify and synthesize empirical research on the impacts of interest-holder engagement on the guideline development process and content.

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Article Synopsis
  • - Human African trypanosomiasis is a severe neglected tropical disease that can be fatal without treatment, and the WHO has updated its treatment guidelines after a thorough review.
  • - Fexinidazole is now the preferred first-line treatment for patients aged 6 years and over who weigh at least 20 kg, eliminating the need for invasive lumbar punctures for staging the disease.
  • - While fexinidazole improves treatment options and reduces the risk of severe side effects from previous medicines, it remains unavailable for children who don't meet the age or weight criteria, making interim use of pentamidine necessary in some cases.
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Article Synopsis
  • Vitamin D deficiency is common after bariatric surgery and may negatively affect bone health, but the ideal supplementation dosage is unclear.
  • This study aims to compare the effects of different vitamin D doses on adults with obesity undergoing bariatric surgery, including low, moderate, and high doses versus placebo.
  • Five trials with a total of 314 participants were analyzed, indicating that moderate-dose vitamin D (3200 IU/day) could improve vitamin D status with minimal adverse effects compared to a placebo.
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Background And Objective: The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT.

Methods: Through iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance.

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Background: A recommendation by the World Health Organization (WHO) was issued about the use of chest imaging to monitor pulmonary sequelae following recovery from COVID-19. This qualitative study aimed to explore the perspective of key stakeholders to understand their valuation of the outcome of the proposition, preferences for the modalities of chest imaging, acceptability, feasibility, impact on equity and practical considerations influencing the implementation of using chest imaging.

Methods: A qualitative descriptive design using in-depth interviews approach.

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Background: Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines.

Objective: To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist.

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