Joerg J Meerpohl

• Professor
• Director at University Medical Center Freiburg

The American Society of Hematology (ASH) convened 5 guideline panels to develop clinical practice recommendations addressing 5 management areas of highest importance to individuals living with sickle cell disease: pain, cerebrovascular complications, pulmonary and kidney complications, transfusion, and hematopoietic stem cell transplant. Panels wer...

Objectives To systematically identify knowledge clusters and research gaps in the health-related preferences of older patients with multimorbidity by mapping current evidence. Design Evidence map (systematic review variant). Data sources MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Science Citation Index/Social Science Citation Index/-Expanded...

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...

Objectives: Clear communication of systematic review findings will help readers and decision makers. We built on previous work to develop an approach that improves the clarity of statements to convey findings and that draws on Grading of Recommendations Assessment, Development and Evaluation (GRADE). Study design and setting: We conducted worksh...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: We will assess the overall efficacy of auditory stimulation for physiological and neurodevelopmental outcomes in preterm infants (< 37 weeks' gestation), compared to standard care. In addition, we will determine specific effects of various musical and vocal inte...

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, gu...

Background: Genomics-based noninvasive prenatal tests (NIPT) allow screening for chromosomal anomalies such as Down syndrome (trisomy 21). The technique uses cell-free fetal DNA (cffDNA) that circulates in the maternal blood and is detectable from 5 weeks of gestation onwards. Parents who choose to undergo this relatively new test (introduced in 2...

Description: Dietary guideline recommendations require consideration of the certainty in the evidence, the magnitude of potential benefits and harms, and explicit consideration of people's values and preferences. A set of recommendations on red meat and processed meat consumption was developed on the basis of 5 de novo systematic reviews that cons...

Background: Current data suggest that approximately 466 million people (5.0%) of the world's population have disabling hearing loss, therefrom, 34 million children, impacting their quality of life. To provide estimates on the prevalence of hearing loss on a national level, we reviewed the epidemiological literature addressing hearing loss in child...

Introduction Interaction of conditions and treatments, complicated care needs and substantial treatment burden make patient–physician encounters involving multimorbid older patients highly complex. To optimally integrate patients’ preferences, define and prioritise realistic treatment goals and individualise care, a patient-centred approach is reco...

Background: Donors other than matched siblings and low-intensity conditioning regimens are increasingly used in haematopoietic stem cell transplantation. We aimed to compare the relative risk of donor type and conditioning regimen intensity on the transplantation outcomes of in patients with sickle cell disease. Methods: For this retrospective c...

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 nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. Objective...

Objectives In 2009, not all journal editors considered systematic reviews (SRs) to be original research studies, and not all PubMed Core Clinical Journals published SRs. The aim of this study was to conduct a new analysis about editors’ opinion regarding SRs as original research. Design We conducted a survey and qualitative interview study of jour...

Ergebnisse aus klinischen Studien unterliegen häufig einem Risiko für Bias (Abweichung von der Wahrheit, systematischer Fehler). Die kritische Bewertung von Studien nimmt deshalb einen hohen Stellenwert in der evidenzbasierten Medizin ein. Im vorliegenden Artikel werden häufige Biastypen vorgestellt, voneinander abgegrenzt und Strategien zur Vermei...

Background and aim: This network meta-analysis (NMA) compares the effects of different types of olive oil (OO) on cardiovascular risk factors. Methods and results: Literature search was conducted on three electronic databases (Medline, Web of Science, and Cochrane Central). Inclusion criteria: Randomized controlled trials (RCTs) (≥3 weeks dura...

Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess and report certainty of evidence and strength of recommendations. This GRADE concept article is not GRADE guidance but introduces certainty of net benefit, defined as the certainty that the balance between desirable and undesirable health effects...

Objectives: Timely and comprehensive reporting of clinical trial results builds the backbone of evidence-based medicine and responsible research. The proportion of timely disseminated trial results can inform alternative national and international benchmarking of university medical centers (UMCs). Study design and setting: For all German UMCs, w...

Traditional pairwise meta-analysis (PMA) is a very useful method that pools evidence from one study design type if appropriate; its widespread use in nutrition research is an important phenomenon. Recently, a promising method for more advanced evidence-synthesis, called network meta-analysis (NMA), was introduced. NMA is an extension of PMA that en...

Importance Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies...

Background: A parastomal hernia is defined as an incisional hernia related to a stoma, and belongs to the most common stoma-related complications. Many factors, which are considered to influence the incidence of parastomal herniation, have been investigated. However, it remains unclear whether the enterostomy should be placed through, or lateral t...

Background A parastomal hernia is defined as an incisional hernia related to a stoma, and belongs to the most common stoma-related complications. Many factors, which are considered to influence the incidence of parastomal herniation, have been investigated. However, it remains unclear whether the enterostomy should be placed through, or lateral to...

Background Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a syst...

Background Rare diseases are a global public health priority. Though each disease is rare, when taken together the thousands of known rare diseases cause significant morbidity and mortality, impact quality of life, and confer a social and economic burden on families and communities. These conditions are, by their nature, encountered very infrequent...

Zusammenfassung Die Inhalte von Leitlinien basieren auf der besten verfügbaren Evidenz und werden systematisch erstellt. Die nachvollziehbare Darstellung des Entscheidungsprozesses von der Evidenz zur Empfehlung ist dabei unverzichtbar. Der EtD-Ansatz für Empfehlungen zur klinischen Praxis ermöglicht Leitliniengruppen, ihre Vorgehensweise zu strukt...

Background Back pain is one of the most frequent causes of health-related work absence. In Germany, more than 70% of adults suffer from at least one back pain episode per annum. It has strong impact on health care costs and patients’ quality of life. Patients increasingly seek health information on the internet. However, judging its trustworthiness...

Context Various epidemiological studies suggest a positive association between exposure to cow’s milk A1 β-casein protein and risk for noncommunicable chronic diseases. The consumption of A2 cow’s milk is increasing, likely because A2 milk is postulated to have positive effects on digestive health. Objective A systematic review was conducted to in...

Abstract Following publication of the original article [1], the author reported that their family name was misspelled.

To review the evidence from randomised controlled trials assessing the efficacy of non‐vitamin K antagonist oral anticoagulants (NOACs) post‐percutaneous coronary intervention (PCI) in people with an indication for anticoagulation.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To review the evidence from randomised controlled trials assessing the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention (PCI) in people with an indication for anticoagulation. B A C K G R O U N D Descriptio...

Introduction It is unclear whether early detection of hypertension, through screening, leads to healthier behaviours and better control of blood pressure levels. There is a need to learn from studies that have assessed the impact of different screening approaches on patient important outcomes. This systematic review protocol outlines the methods th...

Die Ständige Impfkommission (STIKO) am Robert Koch-Institut hat im Sommer 2018 ihre Impfempfehlung gegen humane Papillomaviren (HPV) auf Jungen im Alter von 9 bis 14 Jahren ausgeweitet, zusätzlich zu der bereits seit 2007 bestehenden Impfempfehlung für Mädchen. Verpasste Impfungen sollten für beide Geschlechter bis zum Alter von 17 Jahren nachgehol...

Objective To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children. Design Systematic review following standard Cochrane review methodology. Data sources Medline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Plat...

Supplementary file 3: Details of included studies (RCT=randomised, controlled trial; non-RCT=non-randomised controlled trial; AS=artificial sweetener, CVD=cardiovascular disease); *For profit funding includes sponsoring of study material, i.e. intervention substances, as well as financial sponsoring for conducting the study

Supplementary file 2: Results of the assessment of risk of bias in included observational studies

Supplementary file 1: Supplementary materials

Introduction Interaction of conditions and treatments, complicated care needs and substantial treatment burden make patient–physician encounters involving multimorbid older patients highly complex. To optimally integrate patients’ preferences, define and prioritise realistic treatment goals and individualise care, a patient-centred approach is rec...

In May 2016, we launched Research Integrity and Peer Review, an international, open access journal with fully open peer review (reviewers are identified on their reports and named reports are published alongside the article) to provide a home for research on research and publication ethics, research reporting, and research on peer review. As the jo...

Objectives: To evaluate in how many cancer-related Cochrane reviews hazard ratio (HR)-based absolute effects in summary of findings (SoF) tables have been correctly calculated and reported. Study design and setting: We identified all Cochrane cancer intervention reviews that reported an HR for at least one outcome and provided a SoF table, publi...

Background: Several meta-research studies and benchmarking activities have assessed how comprehensively and timely, academic institutions and private companies publish their clinical studies. These current “clinical trial tracking” activities differ substantially in how they sample relevant studies, and how they follow up on their publication. Meth...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce morbidity and mortality associated with hypertension.

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: Abstracts of presentations at scientific meetings are usually available only in conference proceedings. If subsequent full publication of results reported in these abstracts is based on the magnitude or direction of the results, publication bias may result. Publication bias creates problems for those conducting systematic reviews or re...

Objective Timely and comprehensive reporting of clinical trial results build the backbone of evidence-based medicine and responsible research. The proportion of timely disseminated trial results can inform alternative national and international benchmarking of university medical centers (UMCs). Study Design and Setting For all German UMCs we track...

The objective of this paper is to explain how to apply, interpret, and present the results of a new instrument to assess the risk of bias (RoB) in non-randomized studies (NRS) dealing with effects of environmental exposures on health outcomes. This instrument is modeled on the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) instr...

Importance Controversies about the choice of antibiotic agent and treatment modality exist in the management of erythema migrans in early cutaneous Lyme borreliosis (LB). Objective To conduct a network meta-analysis (NMA) of all randomized clinical trials on various antibiotic agents and treatment modalities in early cutaneous LB. Data Sources El...

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to e...

Background: Evidence about the effect on meta-analysis results of including unpublished trials or those published in languages other than English is unclear or discordant. Purpose: To compare treatment effects between published and unpublished randomized controlled trials (RCTs) and between trials published in English and other languages using a...

Background The McMaster RARE‐Bestpractices project group selected the catastrophic antiphospholipid syndrome (CAPS) for a pilot exercise in guideline development for a rare disease. Objectives The objectives of this exercise were to provide a proof of principle that guidelines can be developed for rare diseases, and assist in clinical decision‐mak...

Background: Upper gastrointestinal (GI) bleeding due to stress ulcers contributes to increased morbidity and mortality in people admitted to intensive care units (ICUs). Stress ulceration refers to GI mucosal injury related to the stress of being critically ill. ICU patients with major bleeding as a result of stress ulceration might have mortality...

In healthcare, the processes, criteria, and evidence that decision makers use to reach their judgments often remain unclear. Decision makers sometimes neglect important criteria, give undue weight to criteria, or do not use the best available evidence to inform their judgments. Thus, the GRADE (Grading of Recommendations Assessment, Development and...

Objective: To describe the Grading of Recommendations Assessment, Development and Evaluation (GRADE) interactive Evidence to Decision (EtD) frameworks for tests and test strategies for clinical, public health or coverage decisions. Study design and setting: As part of the GRADE Working Group's DECIDE project we conducted workshops, user testing...

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...

Background The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guidel...

Background Adaptation refers to the systematic approach for considering the endorsement or modification of recommendations produced in one setting for application in another as an alternative to de novo development. Objective To describe and assess the methods used for adapting health–related guidelines published in peer–reviewed journals, and to...

Introduction: The number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section has increased rapidly over the last few years. We conducted a systematic review to inform up-to-date evidence-based guidelines to prevent postpartum infectious morbidity in the mother and rule out any safety issues related t...

Background. Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental and clinical studies indicate that prolonged oxytocin exposure in the first or second stage of labour may be associated with impaired uterine contractility and an increased risk of atonic PPH. Therefore, particularly labouring women...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of non-nutritive sweeteners for diabetes mellitus.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of gastrografin in relieving manifestations of meconium obstruction in newborn infants.

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 for...

Decisions in public health should be based on the best available evidence, reviewed and appraised using a rigorous and transparent methodology. The Project on a Framework for Rating Evidence in Public Health (PRECEPT) defined a methodology for evaluating and grading evidence in infectious disease epidemiology, prevention and control that takes diff...

INTRODUCTION: The European Centre for Disease Prevention and Control is developing evidence-based guidance for voluntary screening, treatment and vaccine prevention of infectious diseases for newly arriving migrants to the European Union/European Economic Area. The objective of this systematic review protocol is to guide the identification, apprais...

A living systematic review (LSR) should keep the review current as new research evidence emerges. Any meta-analyses included in the review will also need updating as new material is identified. If the aim of the review is solely to present the best current evidence standard meta-analysis may be sufficient, provided reviewers are aware that results...

Background Food products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more im...

While it is important for the evidence supporting practice guidelines to be current, that is often not the case. The advent of living systematic reviews has made the concept of "living guidelines" realistic, with the promise to provide timely, up-to-date and high quality guidance to target users. We define living guidelines as an optimization of th...

Systematic reviews are difficult to keep up to date, but failure to do so leads to a decay in review currency, accuracy and utility. We are developing a novel approach to systematic review updating we term 'living systematic review' (LSR): systematic reviews which are continually updated, incorporating relevant new evidence as it becomes available....

New approaches to evidence synthesis, which utilise human effort and machine automation in mutually reinforcing ways, can enhance the feasibility and sustainability of living systematic reviews. Human effort is a scarce and valuable resource, required when automation is impossible or undesirable, and includes contributions from online communities (...

Clinicians do not have the time or resources to consider the underlying evidence for the myriad decisions they must make each day and, as a consequence, rely on recommendations from clinical practice guidelines. Guideline panels should consider all the relevant factors (criteria) that influence a decision or recommendation in a structured, explicit...

Background: Clinical guidelines are developed through a 'multi-step process' that ensures that guidelines are feasible within the current clinical environment and that they are based on the best-available evidence. For example, for the treatment of erythema migrans (EM), the typical clinical sign of early skin infection in Lyme borreliosis (LB), th...

Background: Thalassaemia is a hereditary anaemia due to ineffective erythropoiesis. In particular, people with thalassaemia major develop secondary iron overload resulting from regular red blood cell transfusions. Iron chelation therapy is needed to prevent long-term complications.Both deferoxamine and deferiprone are effective; however, a review...

Objective To assess the effect of specialist palliative care on quality of life and additional outcomes relevant to patients in those with advanced illness. Design Systematic review with meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and trial registers searched up to July 2016. Eligibility...

Appendix: Supplementary text, tables and figures

Background Catastrophic antiphospholipid syndrome (CAPS) is characterized by the rapid onset of widespread or multifocal large and/or small vessel thrombosis associated with multi-organ failure in patients meeting the serological criteria for antiphospholipid syndrome [1]. Mortality in CAPS approaches 50% [2]. Objectives The RARE-BestPractices pro...

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...

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, gu...

Objective: To provide GRADE guidance for assessing risk of bias across an entire body of evidence consequent on missing data for systematic reviews of both binary and continuous outcomes. Study design: Systematic survey of published methodological research, iterative discussions, testing in systematic reviews, and feedback from the GRADE Working...

Objective: To clarify the GRADE (grading of recommendations assessment, development and evaluation) definition of certainty of evidence and suggest possible approaches to rating certainty of the evidence for systematic reviews, health technology assessments and guidelines. Study design and setting: This work was carried out by a project group wi...