Transparent development of the WHO rapid advice guidelines (original) (raw)
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Journal of Clinical Epidemiology, 2021
Highlights Our study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. Despite clear scope, most guidelines for SARS CoV-2 infections and for other care in the context of COVID-19 fell short of basic methodological standards. Only 4% were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). Patients were included in the development of one guideline. A process for regular updates was described in 14%. An insufficient consideration of appropriate methodologies in the guideline development process could lead to misleading information, uncertainty among the professionals, and potentially harmful actions for patients. This paper provides an important benchmark for the future assessment of the quality of COVID-19 guidelines. What is new? Key findings: Despite clear scope, most guidelines for SARS CoV-2 infections and for other care in the context of COVID-19 fell short of basic methodological standards. Only 4% were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). Patients were included in the development of one guideline. A process for regular updates was described in 14%. What this adds to what is known: Our study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. What is the implication/what should change now: An insufficient consideration of appropriate methodologies in the guideline development process could lead to misleading information, uncertainty among the professionals, and potentially harmful actions for patients. This paper provides an important benchmark for the future assessment of the quality of COVID-19 guidelines.
Some thoughts on conducting and implementing clinical practice guidelines in a pandemic
Chinese Medical Journal
A pandemic is a disease that spreads worldwide. When disease is new such as coronavirus disease 2019 (COVID-19), evidentiary basis, by definition, to prevent, diagnose, and treat the disease is limited. Nevertheless, clinical practice guidelines are urgently required to assist policy and healthcare workers to make informed decisions. But, acting in the high-quality evidentiary vacuum, that is, basing guidelines on poor-quality research can be counterproductive and potentially harmful. [1,2] Thus, guideline developers face a number of challenges during a pandemic like COVID-19 that we wish to address in this paper.
2020
Background: The number of published clinical practice guidelines and recommendations related to SARS-CoV-2 infections causing COVID-19 has rapidly increased. However, insufficient consideration of appropriate methodologies in the guideline development could lead to misleading information, uncertainty among professionals, and potentially harmful actions for patients. Purpose: Rapid systematic review of clinical practice guidelines and recommendations in the context of COVID-19 to explore if basic methodological standards of guideline development have been met. Data sources: MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search; from Feb 1st 2020 until April 27th 2020. Study selection: All types of healthcare workers providing any kind of healthcare to any patient population in any setting. Data extraction: At least two reviewers independently extracted guideline characteristics, conducted critical appraisal according to The Appraisal of Guidelines for Research and Evaluation Instr...
The Lancet infectious …, 2007
with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specifi c recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefi ts, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal infl uenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel infl uenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.
South African Health Review
The outbreak of the COVID-19 pandemic posed challenges to the practice of evidence-informed decision-making. Soon after the index case was identified in South Africa, the first local clinical guidelines were developed, reliant on preliminary evidence. Quick decisions were essential to inform practice and procurement at a time of exceptional global demand for medicine supply. This chapter describes how a rapid review mechanism was implemented to enable the development of evidence-informed and context-specific clinical treatment and prevention recommendations for COVID-19 in South Africa. The chapter reflects on the extent to which there is evidence for the implementation of these recommendations in clinical practice, using medicinesutilisation data from the public sector. In order to manage the ‘infodemic’ of research evidence of variable quality, a robust mechanism of rapid evidence review, transparent decision-making, and dissemination of trustworthy, accurate and context-specific ...
Development of rapid guidelines: 2. A qualitative study with WHO guideline developers
Background: Situations such as public health emergencies and outbreaks necessitate the development and publication of high-quality recommendations within a condensed timeframe. For example, WHO has produced examples of and guidance for the development of rapid guidelines (RGs). However, more information is needed to understand the experiences and perceptions of guideline developers. This is the second of a series of three articles addressing methodological issues around RGs. This study describes the perceptions and experiences of guideline developers at WHO about RGs. Methods: We conducted interviews consisting of open-and closed-ended questions with guideline developers at WHO. Our analysis described the definition and rationale of RGs, the differences from regular guidelines with regard to timelines from topic definition until publication, barriers to identifying the evidence and the lack of a standard methodology to develop RGs.
Eurosurveillance, 2013
Control of acute communicable disease incidents demands rapid risk assessment, often with minimal peer-reviewed literature available but conducted in the public's view. This paper explores how methods of evidence-based medicine (EBM) can be applied in this scenario to improve decision making and risk communication. A working group with members from EBM organisations, public health institutions and the European Centre for Disease Prevention and Control used a six-stage framework for rapid risk assessments: preparation, risk detection/verification, risk assessment, development of advice, implementation, and evaluation. It concluded that data from observational studies, surveillance and modelling play a vital role in the evidence base. However, there is a need to further develop protocols and standards, to perform, report and register outbreak investigations more systematically and rigorously, and to allow rapid retrieval of the evidence in emergencies. Lack of evidence for risk assessment and advice (usual for new and emerging diseases) should be made explicit to policy makers and the public. Priorities are to improve templates for reporting and assessing the quality of case and outbreak reports, apply grading systems to evidence generated from field investigations, improve retrieval systems for incident reports internationally, and assess how to communicate uncertainties of scientific evidence more explicitly.
Preparing for pandemics: a systematic review of pandemic influenza clinical management guidelines
BMC Medicine
Background The COVID-19 pandemic has highlighted the importance of evidence-based clinical decision-making. Clinical management guidelines (CMGs) may help reduce morbidity and mortality by improving the quality of clinical decisions. This systematic review aims to evaluate the availability, inclusivity, and quality of pandemic influenza CMGs, to identify gaps that can be addressed to strengthen pandemic preparedness in this area. Methods Ovid Medline, Ovid Embase, TRIP (Turning Research Into Practice), and Guideline Central were searched systematically from January 2008 to 23rd June 2022, complemented by a grey literature search till 16th June 2022. Pandemic influenza CMGs including supportive care or empirical treatment recommendations were included. Two reviewers independently extracted data from the included studies and assessed their quality using AGREE II (Appraisal of Guidelines for Research & Evaluation). The findings are presented narratively. Results Forty-eight CMGs were i...