Carlos Alberto Cuello-Garcia

McMaster University | McMaster · Health Research Methods Evidence and Impact

Bacillus Calmette-Guerín (BCG) is a live attenuated vaccine to prevent tuberculosis, routinely administered at birth as part of the World Health Organization global expanded immunisation programme. Given intradermally, it can cause adverse reactions, including local, regional, distant and disseminated manifestations that may cause parental distress...

To evaluate the effect of presenting a recommendation in a clinical practice guideline using different grading systems to determine to what extent the system used changes the clinician's eventual response to a particular clinical question. Randomised experimental study. Clinician offices and academic settings. Paediatricians and paediatric resident...

Introduction GRADE guidance to rate the certainty domain of imprecision is presently not fully operationalized for rating down by two levels and when different or uncertainty in baseline risks are considered. In addition, there are scenarios in which lowering the certainty of evidence by three levels for imprecision is more appropriate than lowerin...

Objective: The Grades of Recommendations, Assessment, Development and Evaluation working group recently developed an innovative approach to interpreting results from network meta-analyses (NMA) through minimally and partially contextualised methods; however, the optimal method for presenting results for multiple outcomes using this approach remain...

Objective There is little empirical evidence of the impact of pooling randomized controlled trials (RCTs) and cohort studies (CSs) on the certainty-of-evidence. To evaluate the hypothetical-scenario of pooling bodies-of-evidence from RCTs with matched bodies-of-evidence from CSs on the certainty-of-evidence. Study design and setting We extracted G...

Objective: To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are...

Objective: To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. Methods: We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conduct...

Objective: To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are...

Objective: To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. Methods: We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conduct...

This is the 24th in the ongoing series of articles describing the GRADE approach for assessing the certainty of a body of evidence in systematic reviews and health technology assessments and how to move from evidence to recommendations in guidelines. Guideline developers and authors of systematic reviews and other evidence syntheses use randomized...

Background There are uncertainties about mitigating strategies for swimming-related activities in the context of the COVID-19 pandemic. There is an opportunity to learn from the experience of previous re-openings to better plan the future one. Our objectives are to systematically review the evidence on (1) the association between engaging in swimmi...

Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy i...

One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not ex...

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review...

Objectives: The public, policy makers, and science communities are subject to many false, uninformed, overly optimistic, premature, or simply ridiculous health claims. The coronavirus disease 2019 (COVID-19) pandemic and its context is a paramount example for such claims. In this article, we describe why expressing the certainty in evidence to sup...

Background: Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19). Purpose: To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. (PROSPERO registration: CRD42020178187). Data sources: 21 standar...

Introduction Proper strategies to minimise the risk of infection in individuals handling the bodies of deceased persons infected with 2019 novel coronavirus (2019-nCoV) are urgently needed. The objective of this study was to systematically review the literature to scope and assess the effects of specific strategies for the management of the bodies....

There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body wei...

Values and preferences relate to the importance that patients place on health outcomes (eg, bleeding, having a deep venous thrombosis) and are essential when weighing benefits and harms in guideline recommendations. To inform the American Society of Hematology guidelines for management of venous thromboembolism (VTE) disease, we conducted a systema...

Objective: The GRADE system for assessing certainty in a body of evidence currently uses two-levels, serious and very serious, for downgrading on a single domain. In the context of newer risk of bias instruments, such as ROBINS-I, evidence generated by non-randomised studies may justify rating down by more than 2 levels on a single domain. Given t...

Objective To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). Methods Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was fo...

Objective To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non‐systemic polyarthritis, sacroiliitis, or enthesitis. Methods The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review...

Objective To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non‐systemic polyarthritis, sacroiliitis, or enthesitis. Methods The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review...

Objective To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). Methods Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was fo...

Background Many interventions have shown effectiveness in reducing the duration of acute diarrhea and gastroenteritis (ADG) in children. Yet, there is lack of comparative efficacy of interventions that seem to be better than placebo among which, the clinicians must choose. Our aim was to determine the comparative effectiveness and safety of the pha...

Supporting information files. (DOCX)

Background: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions. Objective: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support pat...

Background: Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, function, or both. Hyperglycaemia in non-critically ill hospitalised people is associated with poor clinical outcomes (infections, prolonged hospital stay, poor wound healing, higher morbidity and mortality). In the hospital setting people diagnosed...

Objective To characterize how early mobilization is defined in the published literature and describe the evidence on safety and efficacy on early mobilization in critically ill children. Study design Systematic search of randomized and nonrandomized studies assessing early mobilization-based physical therapy in critically ill children under 18 yea...

Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018094003

Background: As mortality secondary to acute infectious diarrhoea has decreased worldwide, the focus shifts to adjuvant therapies to lessen the burden of disease. Smectite, a medicinal clay, could offer a complementary intervention to reduce the duration of diarrhoea. Objectives: To assess the effects of smectite for treating acute infectious dia...

Objective: To provide guidance on how systematic review authors, guideline developers, and health technology assessment practitioners should approach the use of the risk of bias in non-randomized studies of interventions (ROBINS-I) tool as part of GRADE's certainty rating process. Study design and setting: Iterative discussions, testing in syste...

Objectives: To review the literature and obtain preferences and perceptions from experts regarding the role of randomized studies (RS) and non-randomized studies (NRS) in systematic reviews of intervention effects. Study design and setting: Scoping review and survey of experts. Using levels of certainty developed by the Grading of Recommendation...

Background: To date, a systematic review of the evidence regarding the association between Vitamin D and allergic diseases development has not yet been undertaken. Objective: To review the efficacy and safety of Vitamin D supplementation when compared to no supplementation in pregnant women, breastfeeding women, infants and children for the prev...

Background Allergic rhinitis affects 10 to 40% of the population. It reduces quality of life, school and work performance, and is a frequent reason for office visits in general practice. Medical costs are large but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated sinc...

Background There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development. Meth...

Wprowadzenie: Niniejszy dokument uaktualnia wytyczne Amerykańskiego Towarzystwa Chorób Klatki Piersiowej (ATS)/Europejskiego Towarzystwa Pulmonologicznego (ERS)/Japońskiego Towarzystwa Pulmonologicznego (JRS)/Latynoamerykańskiego Towarzystwa Chorób Klatki Piersiowej (ALAT) dotyczące leczenia idiopatycznego włóknienia płuc. Metody: Przeprowadzono pr...

A pesar de que la vacunación representa una de las estrategias preventivas más efectivas en salud pública, su aplicación siempre ha generado cierto escepticismo...

Background: Allergic diseases are considered a health burden because of their high and constantly increasing prevalence, high direct and indirect costs, and undesirable effects on quality of life. Probiotics have been suggested as an intervention to prevent allergic diseases. Objective: We sought to synthesize the evidence supporting use of probiot...

Background The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20–30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic...

Background: Guideline developers can: 1) adopt existing recommendations from others; 2) adapt existing recommendations to their own context; or 3) create recommendations de novo. Monetary and non-monetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. Objective: To...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of non-nutritive sweeteners for the prevention or treatment of being overweight or obesity.

Background and aims: Treatments for reducing the duration of acute diarrhoea and gastroenteritis (ADG) have been compared to placebo/standard treatment in randomized control trials (RCTs). Systematic reviews have synthesized some of these results. No summary of all the available evidence is available Methods: We conducted a systematic review of RCT...

Background: Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers' judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels. Methods:...

Post-operative ileus is a common condition among pediatric patients undergoing appendectomy. We aim to assess the feasibility, safety, and effectiveness of chewing gum to reduce ileus, and decrease time to oral tolerance. A randomized trial was conducted in 5 to 18 year old patients that underwent an appendectomy. Subjects in the intervention grou...

The PAHO Regional Revolving Fund for Strategic Public Health Supplies (hereinafterreferred to as the PAHO Strategic Fund or the Strategic Fund), was created in 1999 by the then Director of PAHO at the request of Member States of the Organization. This regional mechanism primarily aims at strengthening the supply and management of essential public h...

Background: The prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Prebi...

Background Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease associated with high morbidity and mortality. Effective treatments for IPF are limited. Several recent studies have investigated novel therapeutic agents for IPF, but very few have addressed their comparative benefits and harms. Methods We performed a Bayesian network m...

Background Acute diarrhea and acute gastroenteritis (AD/AGE) are common among children in low- and middle-income countries (LMIC) and high-income countries (HIC). Supportive therapy including maintaining feeding, prevention of dehydration, and use of oral rehydration solution (ORS), is the mainstay of treatment in all children. Several additional t...

BACKGROUND: Recent literature suggests that hypotonic fluids increase the risk of hospital-acquired hyponatraemia; despite this, hypotonic fluids are widely used. OBJECTIVES: To compare the change in serum sodium following the use of hypotonic (0.3% saline, 0.45% saline) or isotonic (0.9% saline) intravenous (IV) maintenance solutions in hospitalis...

Background: This document updates the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association guideline on idiopathic pulmonary fibrosis treatment. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize all available evidence pertinent to our ques...

Esta obra pretende dar consejos, por parte de una serie de expertos, a tutores en metodología de la investigación clínica y la enseñanza médica, a los proveedores de salud, a los alumnos y a los tutores, sobre cómo se puede trasladar el conocimiento desde la investigación clínica a la práctica. El grupo comprende facilitadores de distintas partes d...

Allergic diseases are considered a health burden because of their high and constantly increasing prevalence, high direct and indirect costs, and undesirable effects on quality of life. Probiotics have been suggested as an intervention to prevent allergic diseases. We sought to synthesize the evidence supporting use of probiotics for the prevention...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of smectite for treating acute infectious diarrhoea in children.

Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics...

Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of sliding scale insulin for non-critical hospitalised adults with diabetes mellitus.