Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an American Academy of Sleep Medicine clinical practice guideline.

Introduction: The purpose of this guideline is to establish clinical practice recommendations for the management of obstructive sleep apnea (OSA) in medically hospitalized adults.

Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. The task force provided a summary of the relevant literature and the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations.

Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

Introduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on management of obstructive sleep apnea in medically hospitalized adults.

Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials and observational studies that addressed interventions for the management of obstructive sleep apnea in medically hospitalized adults.

Prognostic models for cardiovascular and kidney outcomes in people with type 2 diabetes: living systematic review and meta-analysis of observational studies.

Objective: To summarise available evidence regarding the performance metrics of validated prognostic models on cardiovascular and kidney outcomes in adults with type 2 diabetes mellitus.

Design: Living systematic review and meta-analysis of observational studies.

Data Sources: Medline, Embase, Central, and the Cochrane Database of Systematic Reviews from 1 January 2020 to 17 January 2024.

Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

Introduction: This systematic review provides supporting evidence for the accompanying clinical practice guideline on the treatment of central sleep apnea (CSA) syndrome in adults.

Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of positive airway pressure therapies (PAP), non-PAP therapies, and pharmacological treatment to no treatment to improve patient-important outcomes.

Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline.

Introduction: This guideline establishes clinical practice recommendations for treatment of central sleep apnea (CSA) syndromes in adults.

Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The task force provided a summary of the relevant literature and the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations.

The Canadian Society of Nephrology Methods for Developing and Adapting Clinical Practice Guidelines: An Update.

Purpose Of The Review: In this article, we provide an update on the Canadian Society of Nephrology's (CSN) process of identifying candidate topics and subsequent development of guidelines and commentaries using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology. We revise the process of adapting existing guidelines with the inclusion of Kidney Disease Improving Global Outcomes (KDIGO) practice points. We also describe challenges of implementing guidelines and suggest solutions to address this with description of the CSN approach to disseminating and implementing guidelines.

GRADE Certainty Ratings: Thresholds Rather Than Categories of Contextualization (GRADE Guidance 41).

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.

Efficacy and Safety of Thrombolysis for Pediatric Venous Thromboembolism: A Systematic Review and Meta-analysis.

We conducted this systematic review to evaluate outcomes of thrombolysis followed by anticoagulation versus anticoagulation alone in pediatric patients with venous thromboembolism (VTE). This systematic review addresses mortality, VTE resolution, recurrence, bleeding, and organ-specific outcomes in five population, intervention, comparison, outcomes (PICO) questions on thrombolysis across pulmonary embolism (PE), extremity deep vein thrombosis (DVT), right atrial thrombosis (RAT), cerebral sinus venous thrombosis (CSVT), and renal vein thrombosis (RVT). Meta-analysis reported risk ratios or differences (95% confidence intervals), and absolute effects per 1,000 patients.

2025 focused update of the 2020 ISTH guidelines for management of thrombotic thrombocytopenic purpura.

Background: Over the past few years, new information has emerged in the management of both immune thrombotic thrombocytopenic purpura (iTTP) and congenital (or hereditary) thrombotic thrombocytopenic purpura (cTTP).

Methods: In March 2024, the International Society on Thrombosis and Haemostasis (ISTH) formed a multidisciplinary panel comprising hematologists, intensivists, nephrologists, pathologists, patient representatives, and a methodology team. The panel discussed all treatment questions related to thrombotic thrombocytopenic purpura (TTP) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method to appraise evidence and formulate recommendations.

Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis.

Objective: To compare the effects of treatments for mild or moderate (that is, non-severe) coronavirus disease 2019 (covid-19).

Design: Systematic review and network meta-analysis.

Data Sources: Covid-19 Living Overview of Evidence Repository (covid-19 L-OVE) by the Epistemonikos Foundation, a public, living repository of covid-19 articles, from 1 January 2023 to 19 May 2024.

Core GRADE 6: presenting the evidence in summary of findings tables.

This sixth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to summary of findings tables. These tables provide essential information about the effects of interventions on patient important outcomes, including relative and absolute effects, certainty of evidence, and a plain language summary. For binary outcomes calculating absolute effects requires applying relative risk estimates to baseline risks from studies representative of the target population.

American Society of Hematology/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients.

Background: The American Society of Hematology (ASH) guidelines on treatment of pediatric venous thromboembolism (VTE) were published in 2018. In the last 6 years, there has been a 10-fold increase in the number of children involved in VTE treatment trials.

Objective: The ASH Committee on Quality and Guidelines agreed to update the pediatric guidelines in conjunction with the International Society on Thrombosis and Haemostasis (ISTH).

Core GRADE 5: rating certainty of evidence-assessing indirectness.

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness.

2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis.

Objective: The objective is to provide evidence-based and expert guidance for the screening, treatment, and management of lupus nephritis.

Methods: The Core Team developed clinical questions for screening, treatment, and management of lupus nephritis using the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were completed for each PICO question, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of evidence and to formulate recommendations.

Core GRADE 3: rating certainty of evidence-assessing inconsistency.

This third article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to deciding whether to rate down certainty of evidence due to inconsistency—that is, unexplained variability in results across studies. For binary outcomes in which relative effects are consistent across baseline risks while absolute effects are not, Core Grade users assess consistency in relative effects. For continuous outcomes, they assess consistency in the absolute effects.

Core GRADE 2: choosing the target of certainty rating and assessing imprecision.

This second article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to deciding on the target of the certainty rating, and decisions about rating down certainty of evidence due to imprecision. Core GRADE users assess if the true underlying treatment effect is important or not in relation to the minimal important difference (MID) or, alternatively, if a true underlying treatment effect exists. The location of the point estimate of effect in relation to the chosen threshold determines the target.

Core GRADE 1: overview of the Core GRADE approach.

This first article in a seven part series presents an overview of the essential elements of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach that has proved extremely useful in systematic reviews, health technology assessment reports, and clinical practice guidelines. GRADE guidance has appeared in many articles dealing with both core issues and more specialised and complex guidance, and it has evolved over time. This series of articles presents GRADE essentials, Core GRADE, focusing on the core judgments necessary to summarise the comparative evidence about alternative care options and to make recommendations that apply to the care of individual patients.

Real-World Tolvaptan Use in Autosomal Dominant Polycystic Kidney Disease: Insights from Two US Medical Centers.

Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most prevalent genetic kidney disease leading to kidney failure. Tolvaptan, a Vasopressin V2 receptor antagonist, is the only medication approved by the United States Food and Drug Administration (FDA) for slowing kidney growth in individuals with rapidly progressive ADPKD, but its long-term tolerability and effective implementation has yet to be studied, particularly in real-world clinical settings within the US.

Methods: This retrospective cohort study examined adults with ADPKD treated with tolvaptan at the University of Kansas Medical Center and the University of Iowa Hospitals & Clinics from May 2018 to April 2023.

Enhancing health equity considerations in guidelines: health equity extension of the GIN-McMaster Guideline Development Checklist.

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).

Seven principles for integrating health equity considerations in the practice guideline enterprise.

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.

Nationwide Trends in Stroke Among Patients Undergoing Hemodialysis by Sex and Race: An Analysis From the US Renal Database.

Background: The risk of ischemic stroke hospitalization in patients with end-stage kidney disease has declined over time, but data are limited, especially for hemorrhagic stroke trends. Race- and sex-based differences have not been well studied.

Methods And Results: We conducted a retrospective cohort study using the US Renal Data System to examine the incidence of stroke among incident patients undergoing hemodialysis from 2006 to 2016.

2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis.

Objective: The objective is to provide evidence-based and expert guidance for the screening, treatment, and management of lupus nephritis.

Methods: The Core Team developed clinical questions for screening, treatment, and management of lupus nephritis using the PICO format (population, intervention, comparator, and outcome). Systematic literature reviews were completed for each PICO question, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of evidence and to formulate recommendations.

Rating certainty when the target threshold is the null and the point estimate is close to the null.

When one initially targets the null effect and the point estimate falls close to the null, two challenges exist in rating certainty of evidence. First, when the point estimate is near the null and the data, therefore, suggests little or no effect, rating certainty in a benefit or harm is misleading. Second, since in general the narrower the confidence interval (CI) the more precise the estimate, if the CI is narrow, rating down for imprecision due simply to crossing the null is inappropriate.