Elie Akl

• MD, MPH, PhD
• Managing Director at American University of Beirut

The Middle East and North Africa region are traditionally known as regions with a high prevalence of vitamin D deficiency. However, serum 25-hydroxyvitamin D (25OHD) levels seem to be increasing lately. We developed guidelines on the screening and supplementation of adult Lebanese patients with vitamin D. These guidelines address community-dwelling...

Description: The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients...

Background Practice guidelines may reduce health inequities by addressing preventable and unjust differences in health. However, health equity considerations are often inadequately integrated into the guideline planning and development process. This article describes a pragmatic approach to enhancing health equity considerations within guidelines b...

Background: Guideline developers have increasingly engaged various groups of interest-holders in different stages of guideline development. However, reporting on interest-holder engagement in practice guidelines often lacks transparency. Therefore, the RIGHT (Reporting Items of Practice Guidelines in Healthcare) working group, in collaboration with...

Description: Artificial intelligence (AI) has been defined by the High-Level Expert Group on AI of the European Commission as "systems that display intelligent behaviour by analysing their environment and taking actions-with some degree of autonomy-to achieve specific goals." Artificial intelligence has the potential to support guideline planning,...

Objective The objective of this scoping review is to develop a list of items for potential inclusion in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines for network meta-analysis (NMA), scoping reviews (ScRs), and rapid reviews (RRs). Introduction The PRISMA extensions for NMA and ScRs were publi...

From 2019 to 2023, a subset of 80 highly published universities demonstrated research output increases exceeding 100%, compared to the global average of 20%. Among these, 14 institutions showed significant declines in first authorship rates, raising questions about their authorship and affiliation practices. This study employed bibliometric analysi...

Background To ensure rigour and transparency in guideline adaptation and contextualization processes, standardized tools and methodological principles are needed. However, methodological challenges have been continuously documented in guideline adaptation processes. Objective To develop a guideline international network (GIN)‐McMaster guidelines d...

Background Health guideline developers engage with interested people and groups to ensure that guidelines and their recommendations are relevant and useful to those who will be affected by them. These ‘interest‐holders’ include patients, payers/purchasers of health services, payers of health research, peer review editors, product makers, programme...

Publications of living systematic reviews (LSRs) are increasing rapidly. Guidance facilitating transparent, complete, and accurate reporting of LSRs is needed. This paper reports the development of an extension of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement for LSRs (PRISMA-LSR). The PRISMA-LSR ext...

Background Given the colonial connotations of the term “stakeholder”, its continued use may be perceived as disrespectful to Indigenous Peoples. While several groups have introduced alternative terms, each has its own limitations. The objective of this article is to introduce “interest‐holders” as an alternative term to “stakeholders” and describe...

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

Background: Vitamin D deficiency following bariatric surgery is common and is expected to be associated with a deleterious impact on the skeleton. However, the benefits of vitamin D supplementation and the optimal dose in this population is currently unknown. The available guidelines on the topic are derived from experts' opinions, and are not evi...

This study includes building on the collective experience of many organizations and following standard methodology for a framework for living practice guidelines in health care

This presentation explores the impact of the COVID-19 pandemic on practice guideline development, specifically the shift from in-person to virtual panel meetings due to social distancing and travel restrictions. It evaluates the benefits and drawbacks of both meeting formats, such as interaction quality, logistics, and consensus-building. Additiona...

Introduction The GRADE-ADOLOPMENT methodology has been widely used to adopt, adapt or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. This guidance refines the operationalization for applying GRADE-ADOLOPMENT. Methods Through iterative discussions, online meetings and email communications, the GRADE...

Between 2019 and 2023, sixteen universities increased their research output by more than fifteen times the global average, alongside significant changes in authorship dynamics (e.g., decreased first authorship, increased numbers of hyperprolific authors, increased numbers of multiaffiliations, and increased numbers of authors per publication). Usin...

Background A recommendation by the World Health Organization (WHO) was issued about the use of chest imaging to monitor pulmonary sequelae following recovery from COVID-19. This qualitative study aimed to explore the perspective of key stakeholders to understand their valuation of the outcome of the proposition, preferences for the modalities of ch...

Background: Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines. Objective: To develop an extension of the Reporting Items for pra...

Introduction To systematically review the effectiveness and unintended health and socioeconomic consequences of public health and social measures (PHSM) aimed at reducing the scale and risk of transmission of coronavirus disease 2019 (COVID‐19). Methods This review followed guidance about overviews of reviews in the Cochrane handbook for systemati...

Background The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare systems globally, particularly in terms of access to medicines. Lebanon has been greatly affected by the pandemic, having faced concomitant financial and economic crises. The objective of the study was to understand the experiences of patients with COVID-19 in Leban...

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...

Background Observational epidemiologic studies provide critical data for the evaluation of the potential effects of environmental, occupational and behavioural exposures on human health. Systematic reviews of these studies play a key role in informing policy and practice. Systematic reviews should incorporate assessments of the risk of bias in resu...

Objectives: Guidelines and essential medicine lists (EMLs) bear similarities and differences in the process that lead to decisions. Access to essential medicines is central to achieve universal health coverage. The World Health Organization (WHO) EML has guided pri-oritization of essential medicines globally for nearly 50 years, and national EMLs (...

Essential medicine lists (EMLs) are important medicine prioritization tools used by the World Health Organization (WHO) EML and over 130 countries. The criteria used by WHO’s Expert Committee on the Selection and Use of Essential Medicines has parallels to the GRADE Evidence-to-Decision (EtD) frameworks. In this study, we explored the EtD framework...

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

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...

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 the...

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 original...

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 includes...

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 includes...

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...

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 complex proce...

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. Metho...

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 f...