GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale

Welch, Vivian; Akl, Elie A.; Guyatt, Gordon; Pottie, Kevin; Eslava-Schmalbach, Javier; Ansari, Mohammed; Beer, Hans de; Briel, Matthias; Dans, Tony; Dans, Inday; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Meerpohl, Joerg J; Morton, Rachael; Mosdøl, Annhild; Petkovic, Jennifer; Schünemann, Holger J.; Sharaf, Ravi; Singh, Jasvinder A.; Stanev, Roger; Tonia, Thomy; Tristán, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter

doi:10.1016/j.jclinepi.2017.01.014

Cited by 81 publications

(79 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also reviewed non-randomized studies that analyzed other socio-economic and cultural aspect that could have an impact on equity. We extracted data on the influence of several factors (i.e age, disability, sexual orientation, time-dependent situations, relationships, place of residence, race/ethnicity/culture, language, occupation, gender/sex, religion, education, socioeconomic status, or social capital) on the absolute effectiveness of PUFAs or the importance of the problem [33,34]. We extracted both quantitative and qualitative data.…”

Section: Equitymentioning

confidence: 99%

“…Watters et al [50] identified supplements as the cheapest way, immediately after fish liver oil, to take a high dosage (≥500 mg/day) of PUFAs such as DHA and EPA. The estimated cost of the equivalent of a tablet containing 1000 mg of EPA plus DHA was $0.88 ± $0.16 in the USA [33]. Similarly, according to another USA study, which considered a wider range of marketed PUFAs' supplements, the estimated cost of the equivalent of a tablet containing 1000 mg EPA plus DHA was $0.70 ± $1.11 [51].…”

Section: Resources Requiredmentioning

confidence: 99%

See 1 more Smart Citation

Equity, acceptability and feasibility of using polyunsaturated fatty acids in children and adolescents with autism spectrum disorder: a rapid systematic review

D’Alò

Crescenzo

Morgano

et al. 2020

Health Qual Life Outcomes

Self Cite

View full text Add to dashboard Cite

Introduction: Some recent randomized controlled trials (RCTs) assessed the efficacy and safety of polyunsaturated fatty acids (PUFAs) for the treatment of autism spectrum disorder (ASD). To optimally inform the Italian guideline for the management of ASD in children and adolescents, we reviewed the impact on equity, acceptability and feasibility for developing a pilot recommendation for PUFAs. Methods: We performed a rapid systematic review of observational and experimental studies on PUFAs for children and adolescents with ASD, extracting data on resources required, equity, acceptability, and feasibility of PUFAs. We followed the framework provided by the grading of recommendations assessment, development and evaluation (GRADE) methodology, and we assessed risk of bias and methodological quality of included studies. Results were synthesized both narratively and quantitatively to address clinically relevant questions on equity, acceptability, and feasibility. Results: We found 14 papers related to equity. PUFAs did not seem to impact equity importantly. We did not find variation in effectiveness across subgroups and in a base case scenario, the cost of a 12 weeks cycle of therapy with 1.155 g/day of PUFAs was €65.51 euro. The acceptability of PUFAs was evaluated in 17 studies, 9 of which were RCTs. PUFAs were widely used among children and adolescents with ASD (18 to 51%), and 50% of parents considered nutritional supplementation as useful. Difficulty in swallowing capsules and bad taste were identified as possible causes of poor compliance, but treatment adherence, when measured in included RCTs, was judged to be good to excellent. Discontinuation due to any cause for PUFAs could not differ from placebo (low certainty of evidence). The feasibility of using PUFAs was assessed in 12 studies. PUFAs were probably sustainable, and no particular critical issue emerged from the feasibility assessment. However, the evidence appeared scarce and indirect.

show abstract

Section: Equitymentioning

confidence: 99%

Section: Resources Requiredmentioning

confidence: 99%

Equity, acceptability and feasibility of using polyunsaturated fatty acids in children and adolescents with autism spectrum disorder: a rapid systematic review

D’Alò

Crescenzo

Morgano

et al. 2020

Health Qual Life Outcomes

Self Cite

View full text Add to dashboard Cite

show abstract

“…Incorporating equity into guideline development necessitates modifying the methodology accordingly . This is evidenced by revisions in the second edition of the WHO Handbook for Guideline Development, which has added a new chapter on equity and other social determinants of health; and in the evolving GRADE framework that has recently launched a series that gives detailed guidance on health equity considerations in guideline development …”

Section: Discussionmentioning

confidence: 99%

“…21 This is evidenced by revisions in the second edition of the WHO Handbook for Guideline Development, which has added a new chapter on equity and other social determinants of health; and in the evolving GRADE framework that has recently launched a series that gives detailed guidance on health equity considerations in guideline development. 22,23 The method of collecting CPGs employed was designed using the lens of a health care practitioner attempting to attain CPGs for his/her personal use. We were initially limited by what could be freely accessed online or from office libraries.…”

Section: Discussionmentioning

confidence: 99%

Appraisal of the methodological quality of clinical practice guidelines in the Philippines

Miguel

Silvestre

Imperial³

et al. 2019

Health Planning & Management

View full text Add to dashboard Cite

Summary Purpose The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence‐based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool. Findings Eighty‐seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy‐seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months). Conclusion Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines.

show abstract

“…The quality of the evidence and the confidence in the estimate of the effect across outcomes were assessed utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. 28,29 Accordingly, data from randomized-controlled trials are considered high-quality evidence, but the quality can be rated down due to risk of bias, imprecision, indirectness, imprecision, and publication bias. 29…”

Section: Study Appraisalmentioning

confidence: 99%

Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis

Gazendam

Nucci

Gouveia

et al. 2020

Cannabis and Cannabinoid Research

View full text Add to dashboard Cite

Objective: To synthesize the best evidence surrounding the efficacy of cannabinoids for acute pain in the clinical setting based on subjective pain scores and observed adverse effects. Design: Systematic review with meta-analysis. Data Sources: PubMed, Embase, Cochrane Databases, and Google Scholar. Eligibility Criteria: English-language randomized-controlled clinical trials comparing cannabinoids with placebo in patients with acute pain. Data Extraction and Synthesis: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of three reviewers. Data were pooled through meta-analysis and stratified by route of administration. Primary Outcomes and Measures: Patient-reported pain and adverse events (AEs). Results: Six trials (678 participants) were included examining oral (5 trials) and intramuscular (1 trial) cannabinoids. Overall, there was a small but statistically significant treatment effect favoring the use of cannabinoids over placebo (À0.90, 95% confidence interval [CI] À1.69 toÀ0.1, i 2 = 65%, p = 0.03). When stratified by route of administration, intramuscular cannabinoids were found to have a significant reduction in pain relative to placebo (À2.98, 95% CIÀ4.09 toÀ1.87, i 2 = 0%, p < 0.0001). No difference in effect was observed between oral cannabinoids and placebo (À0.21, 95% CI À0.64 to 0.22, i 2 = 3%, p = 0.34). Serious AEs were rare, and similar across the cannabinoid (14/374, 3.7%) and placebo groups (8/304, 2.6%). Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral. Higher quality, long-term randomized-controlled trials examining whether there may be a role for cannabinoids in treating acute pain are required.

show abstract

GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale

Cited by 81 publications

References 38 publications

Equity, acceptability and feasibility of using polyunsaturated fatty acids in children and adolescents with autism spectrum disorder: a rapid systematic review

Equity, acceptability and feasibility of using polyunsaturated fatty acids in children and adolescents with autism spectrum disorder: a rapid systematic review

Appraisal of the methodological quality of clinical practice guidelines in the Philippines

Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About