Objective to provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. Study Design and Setting literature review followed by group discussions and consensus building. Results The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. Conclusion Guideline projects should consider the above suggestions for recommendations that are equity-sensitive.

Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup.

Background: Forensic psychiatric care treats mentally disordered offenders who suffer mainly from psychotic disorders, although comorbidities such as personality disorders, neurodevelopmental disorders, and substance abuse are common. A large proportion of these patients have committed violent crimes. Their care is involuntary, and their caregivers' mission is complex: not only to rehabilitate the patient, but also to consider their risk for reoffending and their risk to society. The objective of this overview of systematic reviews is to identify, appraise, and summarize the existing knowledge in forensic psychiatric care and identify knowledge gaps that require further research.Methods: We undertook a systematic literature search for systematic reviews in five defined domains considered important in daily clinical practice within the forensic psychiatric care: (1) diagnostic assessment and risk assessments; (2) pharmacological treatment; (3) psychological interventions; (4) psychosocial interventions, rehabilitation, and habilitation; and (5) restraint interventions. The target population was mentally disordered offenders (forensic psychiatric patients aged >15 years). Each abstract and full text review was assessed by two of the authors. Relevant reviews then were assessed for bias, and those with moderate or low risk of bias were included.Results: Of 38 systematic reviews meeting the inclusion criteria, only four had a moderate risk of bias. Two aimed to incorporate as many aspects of forensic psychiatric care as possible, one investigated non-pharmacological interventions to reduce aggression in forensic psychiatric care, and one focused on women with intellectual disabilities in forensic care. However, most of the primary studies included in these reviews had high risks of bias, and therefore, no conclusions could be drawn. All of our identified domains must be considered knowledge gaps.Conclusion: We could not answer any of our research questions within the five domains because of the high risk of bias in the primary studies in the included systematic reviews. There is an urgent need for more research on forensic psychiatric care since all of our studied domains were considered knowledge gaps.

Background Systematic reviews (SR) are crucial to evidence-based medicine, but associated conflict of interest remains under-investigated. We set out to compare disclosure of financial conflicts of interest (fCOI) of authors with publically available information and risk of bias (RoB) in SR on the effect of Methylphenidate for treatment of Attention Deficit Hyperactivity Disorder. Methods A librarian searched Medline, Cochrane Library, Embase and PsycInfo in December, 2020. PRISMA guidelines were adopted for selection. Two blinded researchers independently searched open websites for information on fCOI for all authors of all included SR. ´ Disclosure on fCOI was extracted from full-text versions of SR. RoB was judged using Cochrane´s tool for SR. Results Disclosure on fCOI was missing for 2/44 (5%) included SR. For 15 (34%) SR, at least one author disclosed fCOI, and confirmed by open websites in all cases. Authors of 27 (61%) SR disclosed no fCOI, but discordant information was publically available for 8 (30%). In all, 23/44 (55%) of SR were associated with fCOI. RoB was high for 37/44 (84%) SR; 18 (49%) with and 19 (51%) without fCOI noticed on open websites. For the remaining 7 SR with low risk of bias, the corresponding figures were 6 (86%) with and 1 (14%) without fCOI. Conclusion The findings indicated an underreporting of fCOI corresponding to one third of SR disclosing no fCOI, methodological shortcomings were common, and 43/44 (98%) SR were compromised by either high RoB, or by fCOI. Similar investigations on other topics for comparison are warranted.