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.

Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes: a living clinical practice guideline.

Clinical Question: What are the benefits and harms of medications for adults with type 2 diabetes at varied risks of cardiovascular and kidney related complications?

Context: Emerging clinical trials of novel medications have demonstrated benefits on cardiovascular, kidney, and weight related outcomes in people with type 2 diabetes. Dynamically updated practice guidelines adhering to standards of trustworthiness are necessary in response to a rapidly evolving evidence base and the availability of multiple medication alternatives. This living practice guideline incorporates the latest available medications and evidence and provides recommendations stratified by risks of cardiovascular and kidney complications to inform diabetes management.

Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis.

Objective: To provide up-to-date evidence on key benefits, harms, and uncertainties regarding medications for adults with type 2 diabetes.

Design: Living systematic review and network meta-analysis (NMA), using frequentist random effects and GRADE (grading of recommendations, assessment, development and evaluation) approaches. Updates are planned at least two times a year.

Reporting guideline for chatbot health advice studies: The CHART statement.

The Chatbot Assessment Reporting Tool (CHART) is a reporting guideline developed to provide reporting recommendations for studies evaluating the performance of generative artificial intelligence (AI)-driven chatbots when summarizing clinical evidence and providing health advice, referred to as Chatbot Health Advice (CHA) studies. CHART was developed in several phases after performing a comprehensive systematic review to identify variation in the conduct, reporting and methodology in CHA studies. Findings from the review were used to develop a draft checklist that was revised through an international, multidisciplinary modified asynchronous Delphi consensus process of 531 stakeholders, three synchronous panel consensus meetings of 48 stakeholders, and subsequent pilot testing of the checklist.

Reporting Guideline for Chatbot Health Advice Studies: The CHART Statement.

Importance: The rise in chatbot health advice (CHA) studies is accompanied by heterogeneity in reporting standards, impacting their interpretability.

Objective: To provide reporting recommendations for studies evaluating the performance of generative artificial intelligence (AI)-driven chatbots when summarizing clinical evidence and providing health advice.

Design, Setting, And Participants: CHART was developed in several phases after performing a comprehensive systematic review to identify variation in the conduct, reporting, and methodology in CHA studies.

Reporting guideline for Chatbot Health Advice studies: the CHART statement.

Background: The Chatbot Assessment Reporting Tool (CHART) is a reporting guideline developed to provide reporting recommendations for studies evaluating the performance of generative artificial intelligence (AI)-driven chatbots when summarizing clinical evidence and providing health advice, referred to as Chatbot Health Advice (CHA) studies.

Methods: CHART was developed in several phases after performing a comprehensive systematic review to identify variation in the conduct, reporting, and methodology in CHA studies. Findings from the review were used to develop a draft checklist that was revised through an international, multidisciplinary modified asynchronous Delphi consensus process of 531 stakeholders, three synchronous panel consensus meetings of 48 stakeholders, and subsequent pilot testing of the checklist.

Addressing Knowledge Gaps in the Early Detection of Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation: An Official American Thoracic Society Research Statement.

Bronchiolitis obliterans syndrome (BOS) is a late-onset noninfectious pulmonary complication of allogeneic hematopoietic cell transplant (HCT) that is often diagnosed at an advanced stage with severe lung impairment. Increasing use of HCT for the treatment of hematologic diseases worldwide translates to an increasing burden of BOS, particularly for the community pulmonologist. Early recognition of BOS, which offers the best opportunity to mitigate morbidity and mortality, is hampered by incomplete knowledge of the clinical course and disease process.

Comparative effectiveness of interventions to facilitate deprescription of benzodiazepines and other sedative hypnotics: systematic review and meta-analysis.

Objective: To review evidence from randomised trials assessing the effectiveness of strategies to deprescribe benzodiazepines and closely related sedative hypnotics (BSH).

Design: Systematic review and meta-analysis of randomised controlled trials.

Data Sources: MEDLINE, Embase, CINAHL, PsycInfo, and CENTRAL, searched from inception to August 2024, and reference lists of included studies and similar systematic reviews.

Core GRADE 7: principles for moving from evidence to recommendations and decisions.

This seventh article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for moving from evidence to recommendations or policy decisions. Core GRADE users make strong recommendations for an intervention versus a comparator when the desirable consequences clearly outweigh the undesirable consequences, and a conditional (weak) recommendation when the balance is less clear. Primary considerations in deciding on recommendations considering an individual patient perspective include balance of benefits, harms, and burdens; the certainty of evidence; and values and preferences.

Equipping physicians for benzodiazepine receptor agonists deprescription in older adults: theory-based development of the BE-SAFE intervention.

Background: Benzodiazepine receptor agonists (BZRA) are still widely used for sleep problems in older adults despite an unfavourable risk-benefit ratio. The hospital setting presents an opportunity for optimising medication use in older adults. The BE-SAFE project follows a rigorous sequential approach for developing a theory-informed intervention towards BZRA deprescription initiated in the hospital setting in 6 European countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland).

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.

Metformin for covid-19: systematic review and meta-analysis of randomised controlled trials.

Objective: To summarise the effects of metformin on covid-19 to inform a World Health Organization (WHO) clinical practice guideline.

Design: Systematic review and meta-analysis.

Data Sources: As part of a living systematic review and network meta-analysis of drug treatments for covid-19 (covid-19 LNMA), a search was performed of the WHO covid-19 database, six Chinese databases, and the Epistemonikos Foundation's Living Overview of the Evidence covid-19 Repository (covid-19 L-OVE).

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.

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.

Effects of Janus kinase inhibitors in adults admitted to hospital due to COVID-19: a systematic review and individual participant data meta-analysis of randomised clinical trials.

Background: Evidence from randomised clinical trials (RCTs) of Janus kinase (JAK) inhibitors-compared with usual care or placebo-in adults treated in hospital for COVID-19 is conflicting. We aimed to evaluate the benefits and harms of JAK inhibitors compared with placebo or usual care and whether treatment effects differed between prespecified participant subgroups.

Methods: For this systematic review and individual participant data meta-analysis (IPDMA), we searched Medline via Ovid, Embase via Elsevier, the Cochrane Central Register of Controlled Trials, the Cochrane COVID-19 Study Register, and the COVID-19 L·OVE Platform, including backward and forward citation searching (last search Nov 28, 2024), for RCTs (unpublished or published in any format and any language) that randomly assigned adults (aged ≥16 years) admitted to a hospital due to COVID-19 to receive either a JAK inhibitor (any type) or no JAK inhibitor (ie, received site-specific standard of care with or without placebo), and requested individual participant data (IPD) from the original trial teams.

Core GRADE 4: rating certainty of evidence-risk of bias, publication bias, and reasons for rating up certainty.

This fourth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to addressing risk of bias, publication bias, and rating up certainty. In Core GRADE, randomised controlled trials begin as high certainty evidence and non-randomised studies of interventions (NRSI) as low certainty. To assess certainty of evidence for risk of bias, Core GRADE users first classify individual studies as low or high risk of bias.

Adapting World Health Organization COVID-19 living guidelines balancing methodological rigor with efficiency and flexibility: a case study from Argentina.

Objectives: We assessed the perceptions about a new methodological process to translate and adapt the World Health Organization living guidelines for COVID-19 recommendations for therapeutics in Argentina from the guideline development group's (GDG) perspective.

Methods: A tailored adaptation process, linked to a prototype tool and created as part of the GATEWAY project by the MAGIC Evidence Ecosystem Foundation, starts by assessing the recommendation and justification and then examining evidence to decision factors. We focused our evaluation on the adaptation process steps carried out from December 2022 to June 2023.

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.