scholarly journals Systematic review of immunosuppressant guidelines in the COVID-19 pandemic

2021 ◽  
Vol 12 ◽  
pp. 204209862098568
Author(s):  
Fenella Barlow-Pay ◽  
Thura Win Htut ◽  
Mina Khezrian ◽  
Phyo Kyaw Myint
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
English Language ◽  
Viral Infections ◽  
Evidence Base ◽  
The Novel ◽  
Level Of Evidence ◽  
High Doses

Aims: Individuals taking immunosuppressants are at increased susceptibility to viral infections in general. However, due to the novel nature of the COVID-19, there is a lack of evidence about the specific risks of the disease in this patient group. This systematic review aims to summarize the current international clinical guidelines to highlight areas where research is needed through critical appraisal of the evidence base of these guidelines. Methods: We conducted a systematic review of clinical practice guidelines about the usage of immunosuppressants during the COVID-19 pandemic. Electronic databases including MEDLINE and the websites of relevant professional bodies were searched for English language guidelines that were published or updated between March 2020 and May 2020 in this area. We assessed the quality and consistency of guidelines. The evidence base underpinning these guidelines was critically appraised using GRADE criteria. Results: Twenty-three guidelines were included. Most guidelines ( n = 15, 65.2%) informed and updated evidence based on expert opinion. The methodological quality of the guidelines varied, ranging from ‘very low’ to ‘moderate’. Guidelines consistently recommended that high-risk patients, including those who are taking high doses of steroids for more than a month, or a combination of two or more immunosuppressants, should be shielding during the outbreak. Most guidelines stated that steroids usage should not be stopped abruptly and advised on individualized risk–benefit analysis considering the risk of the effect of COVID-19 infection and the relapse of the autoimmune condition in patients. Discussion: Clinical practice guidelines on taking immunosuppressants during the COVID-19 outbreak vary in quality. The level of evidence informing the available guidelines was generally low. Given the novel nature of COVID-19, the guidelines draw on existing knowledge and data, refer to the use of immunosuppressants and risks of serious infections of other aetiologies and have extrapolated these to form their evidence base.

scholarly journals A Systematic Review of Clinical Practice Guidelines’ Recommendations on Levothyroxine Therapy Alone versus Combination Therapy (LT4 plus LT3) for Hypothyroidism

2015 ◽  
Vol 38 (6) ◽  
pp. 305 ◽  
Author(s):  
Eyal Kraut ◽  
Pendar Farahani
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Combination Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
English Language ◽  
Experimental Treatment ◽  
Standard Of Care ◽  
Mesh Terms ◽  
Pediatric Populations

Purpose: Patients with hypothyroidism are increasingly enquiring about the benefit of using combination therapy of levothyroxine (LT4) and liothyronine (LT3) as a potential treatment for hypothyroidism. Combination therapy, however, remains controversial. The purpose of this study was to systematically review available hypothyroidism treatment recommendations from clinical practice guidelines from around the world to identify the consensus regarding combination therapy. Source: Clinical practice guidelines were obtained from searches of PubMed, EMBASE, and MEDLINE, using several combinations of MeSH terms. The search was limited to clinical guidelines in English-language publications, published between January 1, 1990 and May 1, 2015. A quantitative approach was utilized for data synthesis. Principal Findings: Thirteen guidelines were identified, including three regarding pregnancy, two regarding pediatric populations and eight regarding adult populations. There were six guidelines from North America, four guidelines from Europe and three guidelines from South America. Twelve of the guidelines were published after 2010. Nine guidelines addressed combination therapy of LT4 plus LT3, and all nine concluded that LT4 therapy alone is the standard of care, with insufficient evidence to recommend widespread combination therapy. Only the 2012 ETA Guidelines and the 2015 BTA Guidelines concluded that combination therapy could be used, although only in certain circumstances and as an experimental treatment. Conclusion: This systematic review illustrates that clinical practice guidelines worldwide do not recommend and do not support routine use of combination LT4 and LT3 therapy to treat hypothyroidism.

scholarly journals Quality assessment and comparative analysis on the recommendations of current guidelines on the management of peripheral arterial disease: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047980
Author(s):  
Oliseneku Damien Uyagu ◽  
Cosmas Ofoegbu ◽  
Joseph Ikhidero ◽  
Emeka Chukwuka ◽  
Okezie Enwere ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Comparative Analysis ◽  
Peripheral Arterial Disease ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Arterial Disease ◽  
Level Of Evidence ◽  
Peripheral Arterial ◽  
Current Guidelines

IntroductionPeripheral arterial disease (PAD) is the third leading atherosclerotic arterial disease. There is evidence that there is a high variation in the quality and recommendations of clinical practice guidelines for PAD, leading to the possibility of confusion among clinicians and patients. This study aims to conduct a quality assessment and comparative analysis of the clinical practice guidelines on PAD written between 2010 and 2020.Method and analysisWe aim to perform a systematic review of clinical practice guidelines written between 2010 and 2020. A search for guidelines will be conducted through medical databases Scope, Pubmed, TRIP, Guideline Clearinghouses and specialist international organisations’ specific websites. Guidelines that meet the inclusion criteria will be extracted from the search result. The Appraisal of Guidelines for Research and Evaluation II (AGREE-II instrument) will assess the quality of the selected guidelines. The recommendations, level of evidence and other relevant information will be extracted in a datasheet for qualitative analysis. The score for each guideline’s quality will be represented using charts and central tendency measures for comparison. The summary of recommendations will also be represented in tables for easy comparison for similarities and variations across sections. Finally, the level of evidence on which the recommendations are based will also be noted along with other significant characteristics such as the authors’ financial relationship to the biomedical community. We aim to point out deficiencies present in current guidelines and elucidate areas where recommendations are made with low-level evidence. The results will enable the scientific community to design future research to fill in PAD management knowledge gaps.Ethics and disseminationNo ethical approval was sought. Dissemination will be via journal articles and conference presentations.PROSPERO registration numberCRD42020219176.

scholarly journals Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update

Liver Cancer ◽  
2021 ◽  
pp. 1-43
Author(s):  
Masatoshi Kudo ◽  
Yusuke Kawamura ◽  
Kiyoshi Hasegawa ◽  
Ryosuke Tateishi ◽  
Kazuya Kariyama ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Practice ◽  
Public Relations ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Expert Panel ◽  
Clinical Practices ◽  
Fourth Edition ◽  
Level Of Evidence ◽  
Consensus Statements

The Clinical Practice Manual for Hepatocellular Carcinoma was published based on evidence confirmed by the Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma along with consensus opinion among a Japan Society of Hepatology (JSH) expert panel on hepatocellular carcinoma (HCC). Since the JSH Clinical Practice Guidelines are based on original articles with extremely high levels of evidence, expert opinions on HCC management in clinical practice or consensus on newly developed treatments are not included. However, the practice manual incorporates the literature based on clinical data, expert opinion, and real-world clinical practice currently conducted in Japan to facilitate its use by clinicians. Alongside each revision of the JSH Guidelines, we issued an update to the manual, with the first edition of the manual published in 2007, the second edition in 2010, the third edition in 2015, and the fourth edition in 2020, which includes the 2017 edition of the JSH Guideline. This article is an excerpt from the fourth edition of the HCC Clinical Practice Manual focusing on pathology, diagnosis, and treatment of HCC. It is designed as a practical manual different from the latest version of the JSH Clinical Practice Guidelines. This practice manual was written by an expert panel from the JSH, with emphasis on the consensus statements and recommendations for the management of HCC proposed by the JSH expert panel. In this article, we included newly developed clinical practices that are relatively common among Japanese experts in this field, although all of their statements are not associated with a high level of evidence, but these practices are likely to be incorporated into guidelines in the future. To write this article, coauthors from different institutions drafted the content and then critically reviewed each other’s work. The revised content was then critically reviewed by the Board of Directors and the Planning and Public Relations Committee of JSH before publication to confirm the consensus statements and recommendations. The consensus statements and recommendations presented in this report represent measures actually being conducted at the highest-level HCC treatment centers in Japan. We hope this article provides insight into the actual situation of HCC practice in Japan, thereby affecting the global practice pattern in the management of HCC.

scholarly journals Electronic intrapartum fetal monitoring. A systematic review of international clinical practice guidelines.

2021 ◽  
pp. 100008
Author(s):  
Manoj Mohan ◽  
Joohi Ramawat ◽  
Gene La Monica ◽  
Pradeep Jayaram ◽  
Sherif Abdel Fattah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Fetal Monitoring ◽  
Intrapartum Fetal Monitoring

scholarly journals Systematic review of clinical practice guidelines for adults with fractures: identification of best evidence for rehabilitation to develop the WHO’s Package of Interventions for Rehabilitation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca Gimigliano ◽  
◽  
Sara Liguori ◽  
Antimo Moretti ◽  
Giuseppe Toro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Hip Fracture ◽  
Distal Radius ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Adult Population ◽  
World Health ◽  
The World

Abstract Background The identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO’s Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs. Methods This paper is part of the Best Evidence for Rehabilitation (be4rehab) series, developed according to the methodology presented in the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR) introductory paper. It is a systematic review of existing CPGs on fractures in adult population published from 2009 to 2019. Results We identified 23 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria, we selected 13 CPGs. After checking for quality, publication time, multiprofessionality, and comprehensiveness, we finally included five CPGs dealing with rehabilitative management of fractures in adult population, two CPGs addressing treatment of distal radius fracture and three the treatment of femoral/hip fracture. Conclusion The selected CPGs on management of distal radius and femoral/hip fracture include few recommendations regarding rehabilitation, with overall low to very low quality of evidence and weak/conditional strength of recommendation. Moreover, several gaps in specific rehabilitative topics occur. Further high-quality trials are required to upgrade the quality of the available evidence. Level of evidence Level 1.

scholarly journals Sex and gender considerations in Canadian clinical practice guidelines: a systematic review

CMAJ Open ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. E66-E73 ◽  
Author(s):  
Cara Tannenbaum ◽  
Barbara Clow ◽  
Margaret Haworth-Brockman ◽  
Patrice Voss
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Sex And Gender ◽  
And Gender
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