Addressing Challenges When Applying GRADE to Public Health Guidelines: A Scoping Review Protocol and Pilot Analysis

This is a protocol for a scoping review that aims to determine how guideline authors using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach have addressed previously identified challenges related to public health. The Joanna Briggs Institute (JBI) methodology for scoping reviews will be followed. We will search and screen titles of guidelines for all languages published in 2013–2021 in: the GIN library, BIGG database, Epistemonikos GRADE guidelines repository, GRADEpro Database, MAGICapp, NICE and WHO websites. Two reviewers will independently screen full texts of the documents identified. The following information will be extracted: methods used for identifying different stakeholders and incorporating their perspectives; methods for identification and prioritization of non-health outcomes; methods for determining thresholds for decision-making; methods for incorporating and grading evidence from non-randomized studies; methods for addressing concerns with conditional recommendations in public health; methods for reaching consensus; additional methodological concerns; and any modifications made to GRADE. A combination of directed content analysis and descriptive statistics will be used for data analysis, and the findings presented narratively in a tabular and graphical form. In this protocol, we present the pilot results from 13 identified eligible guidelines issued between January and August 2021. We will publish the full review results when they become available.

The Primary Care Management of Headache: Synopsis of the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

ABSTRACT Introduction In June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache. Methods In October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine’s tenets for trustworthy clinical practice guidelines. Results The guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. Conclusion This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.

Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women

Background Breastfeeding has been robustly linked to reduced maternal risk of breast cancer, ovarian cancer, and type 2 diabetes. We herein systematically reviewed the published evidence on the association of breastfeeding with maternal risk of cardiovascular disease (CVD) outcomes. Methods and Results Our systematic search of PubMed and Web of Science of articles published up to April 16, 2021, identified 8 relevant prospective studies involving 1 192 700 parous women (weighted mean age: 51.3 years at study entry, 24.6 years at first birth; weighted mean number of births: 2.3). A total of 982 566 women (82%) reported having ever breastfed (weighted mean lifetime duration of breastfeeding: 15.6 months). During a weighted median follow‐up of 10.3 years, 54 226 CVD, 26 913 coronary heart disease, 30 843 stroke, and 10 766 fatal CVD events were recorded. In a random‐effects meta‐analysis, the pooled multivariable‐adjusted hazard ratios comparing parous women who ever breastfed to those who never breastfed were 0.89 for CVD (95% CI, 0.83–0.95; I 2 =79.4%), 0.86 for coronary heart disease (95% CI, 0.78–0.95; I 2 =79.7%), 0.88 for stroke (95% CI, 0.79–0.99; I 2 =79.6%), and 0.83 for fatal CVD (95% CI, 0.76–0.92; I 2 =47.7%). The quality of the evidence assessed with the Grading of Recommendations Assessment, Development, and Evaluation tool ranged from very low to moderate, which was mainly driven by high between‐studies heterogeneity. Strengths of associations did not differ by mean age at study entry, median follow‐up duration, mean parity, level of adjustment, study quality, or geographical region. A progressive risk reduction of all CVD outcomes with lifetime durations of breastfeeding from 0 up to 12 months was found, with some uncertainty about shapes of associations for longer durations. Conclusions Breastfeeding was associated with reduced maternal risk of CVD outcomes.

The relationship between telework from home and employee health: a systematic review

Background Globalization and technological progress have made telework arrangements such as telework from home (TWFH) well-established in modern economies. TWFH was rapidly and widely implemented to reduce virus spread during the Coronavirus disease (COVID-19) pandemic, and will probably be widespread also post-pandemic. How such work arrangements affect employee health is largely unknown. Main objective of this review was to assess the evidence on the relationship between TWFH and employee health. Methods We conducted electronic searches in MEDLINE, Embase, Amed, PsycINFO, PubMed, and Scopus for peer-reviewed, original research with quantitative design published from January 2010 to February 2021. Our aim was to assess the evidence for associations between TWFH and health-related outcomes in employed office workers. Risk of bias in each study was evaluated by the Newcastle-Ottawa Scale and the collected body of evidence was evaluated using the the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We included 14 relevant studies (22,919 participants) reporting on 28 outcomes, which were sorted into six outcome categories (general health, pain, well-being, stress, exhaustion & burnout, and satisfaction with overall life & leisure). Few studies, with many having suboptimal designs and/or other methodological issues, investigating a limited number of outcomes, resulted in the body of evidence for the detected outcome categories being GRADED either as low or very low. Conclusions The consisting evidence on the relationship between TWFH and employee health is scarce. The non-existence of studies on many relevant and important health outcomes indicates a vast knowledge gap that is crucial to fill when determining how to implement TWFH in the future working life. Systematic review registration number PROSPERO registration ID # CRD42021233796.

Método Bundle na redução de infecção do sítio cirúrgico: revisão sistemática

Objetivo: conduzir uma revisão sistemática para examinar a evidência científica disponível sobre o efeito do método bundle como ferramenta na redução de infecção do sítio cirúrgico dos pacientes em pós operatório. Método: A busca foi realizada na LILACS, PubMed, Cochrane Library e Scopus. A pergunta de pesquisa foi desenvolvida com uso da estratégia PICOS e a qualidade da evidência foi avaliada pelo sistema Grading of Recommendation, Assessment, Development, and Evaluation (GRADE). Resultados: Das 261 publicações encontradas, dez foram analisadas. Observou-se a prevalência de bundles com 4 a 5 itens de intervenção, sendo que as intervenções com maior frequência foram a antibioticoprofilaxia (50%) e o banho pré-operatório (50%). Conclusão: Com base nas evidências disponíveis, o uso do método bundle na prevenção de infecção do sítio cirúrgico pode reduzir o número de infecções, embora a qualidade de evidência para o desfecho seja baixa. É necessário enfatizar que a qualidade da literatura sobre o assunto não se mostra forte, com pouquíssimos estudos randomizados e cegos.

The Use of Evidence-Based Acupuncture: Current Evidence

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

Background This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol. Methods A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations. Results The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries. Conclusion A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.

Effectiveness and Efficacy of Therapeutic Interventions Performed by Nurses for Anxiety Disorders: A Systematic Review

BACKGROUND: Anxiety disorders are characterized by excessive anxiety, fear, and behavioral disorders that can lead the individual to have losses in daily, social, and work activities, generating a negative impact on their quality of life. AIM: To evaluate the quality of evidence of the therapeutic interventions performed by nurses for anxiety disorders. METHOD: An analysis of the quality of evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The systematic review protocol was registered in the Prospective Register of Systematic Reviews (Prospero), CRD420202939. RESULTS: The interventions performed by nurses were effective ( d = 0.44), with significant improvement in reducing anxiety levels, reducing drug use, and improving self-control. CONCLUSIONS: The study indicates that therapeutic interventions performed by nurses are beneficial for individuals who suffer from anxiety disorders, with significant improvement in reducing anxiety levels, reducing medication use, improving self-control, and remission of anxiety symptoms.

High-Stakes Assessments in Online Competency-Based Higher Education

Assessment is the cornerstone of competency-based higher education because the outcome of the assessment ultimately determines whether the student has demonstrated competence in a job-related skill and is thus able to advance in one's career. As a result, the assessment development process must be sufficiently thorough and data-driven to produce high quality assessments. To address concerns and changes in higher education, a multi-stage, longitudinal assessment development cycle is proposed. In Stage 1, assessment specifications and design are established. Stage 2 culminates in the building of assessment forms and standard setting. Stage 3 involves administration and scoring of assessments. Stage 4 focuses on evaluating the validity of assessments via several assessment quality indicators (AQIs). Finally, these stages repeat over time due to a variety of factors such as aberrations in the AQI metrics and the results of large-scale validity studies, resulting in continuous quality improvement of assessments.

Effect of Soy Isoflavones Supplementation on Adiponectin Levels in Postmenopausal Women

Decreased adiponectin levels has been demonstrated in postmenopausal (PMP) women. Soy isoflavones, as an herbal product have been shown to increase adiponectin level but the results are inconclusive and inconsistent. The present study reassessed the data on the impact of soy isoflavones supplementation on adiponectin levels in PMP women through a meta-analysis. A systematic search was performed in the databases of PubMed, Web of science, Scopus and the Cochrane library. The literature search identified 830 studies with duplicates. Out of those, 80 were screened for title and abstract and 12 articles were ultimately selected for the analysis. Meta-regression and subgroup analyses, based on the moderator variables such as treatment duration, dose of soy isoflavones and BMI were performed. The quality of the studies was evaluated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. The results revealed that soy isoflavones supplementation significantly increased the circulating level of adiponectin in PMP women (SMD: 0.36 µg/mL; 95% CI (0.05 to 0.66); P= 0.02). No publication bias was observed using Begg's (P = 0.38) and Egger's (P = 0.07) tests. Sensitivity analysis indicated the results were completely powerful and stable. Moreover, Meta-regression and subgroup analyses indicated a significant increase of adiponectin levels in subgroups of dose > 50 mg and treatment duration less or equal 3 months. Our findings showed significantly increase in adiponectin levels after isoflavones-supplemented soy consumption in postmenopausal women, who received dose > 50 mg of soy isoflavones in treatment duration ≤ 3 months.