Elie Akl

American University of Beirut | AUB · Department of Internal Medicine

The quality of reporting practice guidelines is often poor, and there is no widely accepted ­guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines fo...

Response to the COVID-19 pandemic included a wide range of Public Health and Social Measures (PHSM). PHSM refer to a broad array of nonpharmaceutical interventions implemented by individuals, communities and governments to reduce the risk and scale of transmission of epidemic- and pandemic-prone infectious diseases. In order to inform decisions by...

Background COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COV...

Background: Currently, there are no guidelines for the treatment of rheumatoid arthritis (RA) tailored to the context of the Kingdom of Saudi Arabia (KSA). Adaptation of guidelines accounts for contextual factors and becomes more efficient than de novo guideline development when relevant, good quality, and up-to-date guidelines are available. The...

Wednesday, September 20, 2023 4:30 PM - 5:30 PM Plenary 3 - Sustainability Through Prioritization Main Auditorium (1) Sustain, Uptake, and Update: A tale of two guideline programs Dr. Yasser Abdel Dayem Amer, King Saud University Medical City, Riyadh, Saudi Arabia, Saudi Arabia (2) Zero, Fifty, Hundred: a Sustainable Guideline Development Model...

Background Guideline development can be a lengthy and resource consuming process. Also, duplication of efforts contributes to research waste. Adoption of guidelines, while an efficient alternative, fails to consider contextual factors which may impact the final recommendations. Therefore, adaptation of developed guidelines provides an alternative s...

Background Guideline adaptation allows for developing trustworthy recommendations using rigorous processes while limiting intensive use of resources. New frameworks, tools, and experience papers are continuously emerging to better inform the adaptation process. Objective To assess and map adaptation methods and processes through a scoping review, a...

GIN 2023 Hybrid Conference | 19 – 22 September | Abstract Book P a g e | 303 The development of GIN-McMaster checklist extension for guideline adaptation Dr Yang Song1, Yuan Zhang2, Yasser Amer3, Andrea J. Darzi2, Elie A Akl2,4, Pablo Alonso-Coello1,5, Holger J Schünemann2 1Iberoamerican Cochrane Centre (CCIb) - Biomedical Research Institute Sant P...

Objectives To synthesise the available evidence on the reporting of conflicts of interest (COI) by individuals posting health messages on social media, and on the reporting of funding sources of studies cited in health messages on social media. Data sources MEDLINE (OVID) (2005–March 2022), Embase (2005–March 2022) and Google Scholar (2005–August...

Background: Misinformation poses a serious challenge to clinical and policy decision-making in the health field. The COVID-19 pandemic amplified interest in misinformation and related terms and witnessed a proliferation of definitions. Objective: We aim to assess the definitions of misinformation and related terms used in health-related literatu...

Objective: To describe a methodological approach to explore the concordance of recommendations across guidelines and its application to the case of the WHO recommendations on chest imaging for the diagnosis and management of COVID-19. Study design and setting: We followed a methodological approach applied to a case study that included: defining...

Introduction Rapid systematic reviews (RRs) have the potential to provide timely information to decision-makers, thus directly impacting healthcare. However, consensus regarding the most efficient approaches to performing RRs and the presence of several unaddressed methodological issues pose challenges. With such a large potential research agenda f...

Objectives: To assess the extent to which peer reviewers and journals editors address study funding and authors' conflicts of interests (COI). Also, we aimed to assess the extent to which peer reviewers and journals editors reported and commented on their own or each other's COI. Study design and methods: We conducted a systematic survey of orig...

Background Despite the importance of evidence syntheses in informing policymaking, their production and use remain limited in the Eastern Mediterranean region (EMR). There is a lack of empirical research on approaches to promote and use policy-relevant evidence syntheses to inform policymaking processes in the EMR. Objective This study sought to d...

Purpose: To review the literature on health research collaborations by academic entities and to identify the main phases, components, and concepts of these research collaborations. Method: The authors conducted a systematic review of the literature, searching 4 databases in March 2022 for studies on health research collaboration between an acade...

Objectives: This GRADE concept article offers systematic reviewers, guideline authors and other users of evidence assistance in addressing randomized trial situations in which interventions or comparators differ from those in the target people, interventions, comparators, outcomes (PICO). To clarify what GRADE considers under indirectness of inter...

Established in 2015, the Multi-Stakeholder Engagement (MuSE) Consortium is an international network of over 120 individuals interested in stakeholder engagement in research and guidelines. The MuSE group is developing guidance for stakeholder engagement in the development of health and healthcare guideline development. The development of this guida...

Background Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, a...

Living systematic reviews (LSRs) are systematic reviews that are continually updated, incorporating relevant new evidence as it becomes available. LSRs are critical for decision-making in topics where the evidence continues to evolve. It is not feasible to continue to update LSRs indefinitely; however, guidance on when to retire LSRs from the livin...

Background: In arterial line cannulation in children and adolescents, traditional methods of locating the artery include palpation and Doppler auditory assistance. It is unclear whether ultrasound guidance is superior to these methods. This is an update of a review originally published in 2016. Objectives: To evaluate the benefits and harms of u...

Objectives: To update previous GRADE guidance addressing inconsistency and interpreting subgroup analyses. Study design and setting: Using an iterative process, we consulted with members of the GRADE working group through multiple rounds of written feedback and discussions at GRADE working group meetings. Results: The guidance complements prev...

Objective: The objectives of this study are to describe the characteristics of Living Systematic Reviews (LSRs) and to understand their life cycles. Study design and setting: We conducted a comprehensive search up to April 2021 then selected articles and abstracted data in duplicate and independently. We undertook descriptive analyses and calcul...

Objectives: As part of an effort to develop an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for living systematic reviews (LSRs), we discuss conceptual issues relevant to the reporting of LSRs and highlight a few challenges. Methods: Discussion of conceptual issues based on a scoping...

BACKGROUND Misinformation poses a serious challenge to clinical and policy decision-making in the health field. The COVID-19 pandemic amplified interest in misinformation and related terms and witnessed a proliferation of definitions. OBJECTIVE We aim to assess the definitions of misinformation and related terms used in health-related literature....

Objective: To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). Methods: This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which inclu...

Objective: To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). Methods: This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which inclu...

RESUMO A declaração dos Principais Itens para Relatar Revisões Sistemáticas e Meta-análises (PRISMA), publicada em 2009, foi desenvolvida para ajudar revisores sistemáticos a relatar de forma transparente por que a revisão foi feita, os métodos empregados e o que os autores encontraram. Na última década, os avanços na metodologia e terminologia de...

Background Immune-based therapies are standard of care treatment for COVID-19 patients requiring hospitalization. However, safety concerns related to the potential risk of secondary infections may limit their use. Methods We searched OVID Medline, Ovid EMBASE, SCOPUS, Cochrane Library, clinicaltrials.gov, PROSPERO in October 2020 and updated Novem...

Research fellowship programs help medical graduates acquire research skills for an academic career. While our institution employed a large number of research fellows, it did not offer them a formal training program. This study aimed to assess the views of fellows and their mentors regarding the current research fellowship program, and to seek their...

Objective: The World Health Organization Model List of Essential Medicines has led to at least 137 national lists. Essential medicines should be grounded in evidence-based guideline recommendations and explicit decision criteria. Essential medicines should be available, accessible, affordable, and the supporting evidence should be accompanied by a...

Background The 2021 American College of Rheumatology (ACR) rheumatoid arthritis (RA) guideline considers the specific context of the United States which differs from that of Saudi Arabia in many aspects that may impact recommendations. The objective of this project was to adapt a set of prioritized recommendations from the 2021 ACR guideline for th...

This article was updated to correct Alessandro Montedori’s name. Collaborative authorship: The GAP Consortium: Yasser Sami Abdel Dayem, Luca Bertolaccini, Pablo Alonso-Coello, Elie Akl, Manish Chand, John J. Como, Gert J. de Borst, Salomone Di Saverio, Sameh Emile, Bang Wool Eom, Ramon Gorter, George Hanna, Kaisa Immonen, Quirino Lai, Nicolaas Lum...

Unlabelled: As the demand for dissemination and implementation (D&I) research grows globally, there is a need for D&I capacity building in regions where D&I science is underrepresented. The Workshop on Dissemination and Implementation Research in Health (WONDIRH) was aimed for participants in the Eastern Mediterranean region to (1) appreciate the...

Objective: To synthesize the available evidence on the disclosure of conflicts of interests by individuals posting health messages on social media, and on the reporting of funding sources of studies cited in health messages on social media Study design: systematic review Data Sources: We developed a search strategy, using the help of a librarian, f...

The Global Evidence Commission report was published in early January 2022. As potential users of the report from France, Lebanon, and South Africa, we have reflected on the value of the report and the next steps for the community. We commend the report for its consideration of a wide range of audiences, and clear recommendations for each. We value...

Background: In visceral leishmaniasis (VL) patients coinfected with human immunodeficiency virus (HIV), combination therapy (liposomal amphotericin B infusion and oral miltefosine) is being considered as an alternative to liposomal amphotericin B monotherapy. We aimed to assess the views of stakeholders in relation to these treatment options. Met...

Objective To provide updated guidance on when GRADE users should consider rating down more than one level for imprecision using a minimally contextualized approach. Study design and setting Based on the first GRADE guidance addressing imprecision rating in 2011, a project group within the GRADE Working Group conducted iterative discussions and pre...

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...

Independent systematic reviewers may arrive at different conclusions when analyzing evidence addressing the same clinical questions. Similarly, independent expert panels may arrive at different recommendations addressing the same clinical topics. When faced with a multiplicity of reviews or guidelines on a given topic, users are likely to benefit f...

Background and objective The living systematic review (LSR) approach is based on an ongoing surveillance of the literature and continual updating. Most currently available guidance documents address the conduct, reporting, publishing and appraisal for systematic reviews (SRs), which is not suitable for LSRs and misses additional LSR-specific consid...

Background: Living practice guidelines are increasingly being used to ensure that recommendations are responsive to rapidly emerging evidence. Objective: To develop a framework that characterizes the processes of development of living practice guidelines in health care. Design: First, 3 background reviews were conducted: a scoping review of me...

Background: COVID-19 related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation in patients with...

Background : While the PRISMA 2020 statement is intended to guide the reporting of original systematic reviews, updated systematic reviews, and living systematic reviews (LSRs), its explanation and elaboration document notes that additional considerations for updated systematic reviews and LSRs may need to be addressed. This paper reports the proto...

Objectives: To assess changes in the reporting of funding and conflicts of interest (COI) in biomedical research between preprint server publications and their corresponding versions in peer-reviewed journals. Study design: We selected preprint servers publishing exclusively biomedical research. From these, we screened articles by order of publi...

This is the protocol for a Campbell systematic review. The objectives are as follows: to identify, describe, and summarize existing guidance and methods for multistakeholder engagement throughout the health guideline development process.

Introduction The COVID-19 pandemic underlined that guidelines and recommendations must be made more accessible and more understandable to the general public, including adults, parents, and youth, to improve health outcomes. The objective of this study is to the public’s (youth, parents, and adult populations) understanding, usability, satisfaction,...

Background: COVID-19 related acute illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in decisions about the use of anticoagulation in patients with COV...

Objective To systematically identify and describe approaches to prioritise primary research topics in any health-related area. Methods We searched Medline and CINAHL databases and Google Scholar. Teams of two reviewers screened studies and extracted data in duplicate and independently. We synthesised the information across the included approaches...

Background: There is a need for the development of comprehensive, global, evidence-based guidance for stakeholder engagement in guideline development. Stakeholders are any individual or group who is responsible for or affected by health- and healthcare-related decisions. This includes patients, the public, providers of health care and policymakers...

This is the protocol for a Campbell systematic review. The overall objective of this study is to gather and summarize the existing literature on conflict of interest issues when engaging stakeholders in guideline development.

Objectives To evaluate the development and quality of actionable statements that qualify as good practice statements (GPS) reported in COVID-19 guidelines. Design and setting Systematic review . We searched MEDLINE, MedSci, China National Knowledge Infrastructure (CNKI), databases of Grading of Recommendations Assessment, Development and Evaluatio...

An evidence-based approach is considered the gold standard for health decision-making. Sometimes, a guideline panel might judge the certainty that the desirable effects of an intervention clearly outweigh its undesirable effects as high, but the body of supportive evidence is indirect. In such cases, the application of the Grading of Recommendation...

Objective Our objective was to develop an extension of the widely used GIN-McMaster Guideline Development Checklist and Tool for the integration of quality assurance and improvement (QAI) schemes with guideline development. Study Design and Setting We used a mixed-methods approach incorporating evidence from a systematic review, an expert workshop...

Objective To develop a digital communication tool to improve the implementation of up-to-date COVID-19 recommendations. Specifically, to improve patient, caregiver and public understanding of healthcare recommendations on prevention, diagnoses and treatment. Study Design and Setting Multi-stakeholder engagement design. In conjunction with the COVI...

Background: Adaptation of existing guidelines can be an efficient way to develop contextualized recommendations. Transparent reporting of the adaptation approach can support the transparency and usability of the adapted guidelines. Objective: To develop an extension of the RIGHT (Reporting Items for practice Guidelines in HealThcare) statement for...

Background : A protocol for a practice guideline can facilitate the guideline development process, ensure its transparency, and improve the quality of the guidelines. However, there are currently no reporting guideline for guideline protocols. Methods : We intend to develop an extension of the Reporting Items for Practice Guidelines in HealThcare (...

Introduction The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and similar Evidence to Decision (EtD) frameworks require its users to judge how substantial the effects of interventions are on desirable and undesirable people-important health outcomes. However, decision thresholds (DTs) that could help understand the magn...

Objective Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. Study Design and Setting We piloted the use of thresholds in a Chilean COVID-19 living guideline....

Background Health research teams increasingly partner with stakeholders to produce research that is relevant, accessible, and widely used. Previous work has covered stakeholder group identification. Objective We aimed to develop factors for health research teams to consider during identification and invitation of individual representatives in a mu...

Objectives: To assess the policies of biomedical preprint servers on the reporting of funding, conflict of interest (COI), author contributions, and research integrity. Study design and setting: We generated a list of potentially eligible preprint servers then judged their eligibility in duplicate and independently. Between July and September 2021,...

Background : While the PRISMA 2020 statement is intended to guide the reporting of original systematic reviews, updated systematic reviews, and living systematic reviews (LSRs), its explanation and elaboration document notes that additional considerations for updated systematic reviews and LSRs may need to be addressed. This paper reports the proto...

Background : While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases o...

Introduction The American University of Beirut Medical Center (AUBMC) developed the Fellowship and Residency Research Program (FRRP) to provide residents and clinical fellows with a supervised and structured research experience. The objective of this study was to explore the views of FRRP participants about the training program and how to enhance i...

Background People with cancer are at increased risk of blood clots. The blood thinner (anticoagulant) administered in the first few days after identifying a blood clot can consist of unfractionated heparin (infused through a vein), low molecular weight heparin (LMWH, injected under the skin once or twice per day; dalteparin and tinzaparin are two d...

Objective This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. Design A qualitative study based on semistructured interviews. We...

Uvod: Preporučene smjernice za izvještavanje u sustavnim pregledima i metaanalizama (engl. Preferred Reporting Items for Systematic reviews and Meta-Analyses, PRISMA) prvi su put objavljene 2009. godine kako bi autorima sustavnih pregleda omogućile transparentno izvještavanje o predmetu istraživanja, korištenim metodama i dobivenim rezultatima. Tij...

Background: COVID-19 related acute illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in decisions about the use of anticoagulation for thromboprophylax...

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: Health guideline development requires sequential prioritization of the guideline topic, questions, and health outcomes. In this paper we report on new approaches for prioritizing questions and outcomes in guidelines. Methods: Ten guideline panels on venous thromboembolism rated potential guideline questions on a 9-point scale according...

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...

Context: The growing number of systematic reviews/meta-analyses (SR/MAs) on vitamin D (±calcium) for fracture prevention has led to contradictory guidelines. This umbrella review aims to assess the quality and explore the reasons for discrepancy of SR/MAs of trials on vitamin D supplementation for fracture risk reduction in adults. Evidence acqui...

Background: Oral anticoagulants may improve the survival of people with cancer through an antithrombotic effect, yet increase the risk of bleeding. Objectives: To evaluate the efficacy and safety of oral anticoagulants in ambulatory people with cancer undergoing chemotherapy, targeted therapy, immunotherapy, or radiotherapy (either alone or in c...

Aim : The objectives of this scoping review are to identify the challenges to conducting evidence synthesis during the COVID-19 pandemic and to propose some recommendations addressing the identified gaps. Methods : A scoping review methodology was followed to map the literature published on the challenges and solutions of conducting evidence synth...