Yang Song

Summary: The journey of guidelines being informed by evidence is less than 50 years old, but it has seen notable advances documented in various publication series and led by key organizations. Although Evidence‐to‐Decision (EtD) frameworks were officially born in 2016, since the early 2000s, groups like GRADE had begun to formulate key determinants of the recommendation‐formulation process. The EtD frameworks started with criteria such as the balance between desirable and undesirable outcomes, values and preferences, and resource use. Nowadays, they are extended to cover criteria like planetary health, human rights, and socio‐cultural acceptability. Experiences with the use of EtD frameworks are generally positive; they are flexible, facilitate multidisciplinary discussions, and bring rigor and transparency to the guidelines. More guidance is required on how to use EtD frameworks, as well as more research to understand how they can lead to better guidelines, and more recently, how artificial intelligence can responsibly help navigate this path.

Nevertheless, the growing concerns about research misconduct (see related terminologies in box 1) bring a new and serious challenge for this well-established system.18 19 During the past decades, retraction rates increased from 10.7 to 44.8 per 100 000 publications, with research misconduct accounting for the most (66.8%).20 Research misconduct can undermine the foundations of evidence-based decision-making: what seems to be the best available evidence may actually be fabricated or manipulated.21 If not properly addressed, the best available evidence may be distorted by fraudulent studies.22 Addressing this problem is challenging, as Grey et al pointed out, ‘retracting untrustworthy, problematic academic publications can take years, and most often never occurs’.23 However, this should not prevent us from taking the first step forward.

Background: The adaptation of clinical practice guidelines (CPGs) is increasingly used to efficiently develop contextualised recommendations for local, regional and national settings. However, adaptation approaches lack standardisation, and their application remains unclear. Objective: To identify existing literature on CPG adaptation approaches, synthesise and analyse the definitions, rationales, key steps and their applications. Methods: We conducted a scoping review and identified studies through (1) database searches in MEDLINE and EMBASE (October 2024); (2) forward citation searches (January 2024); (3) manual searches; and (4) expert recommendations. We included documents describing adaptation approaches that allow reproducibility or adapted guidelines reflecting their application, without language restriction. We analysed data using descriptive and content analysis, with visualisations using Tableau. Results: We identified 49 adaptation approaches (2000–2024) and 151 applications (2007–2024). 28 approaches originated from high-income countries (57.1%), primarily aimed at improving guideline development efficiency. We categorised these approaches into methodological frameworks (n=16, 32.7%), medical association frameworks (n=7, 14.3%), organisational handbooks (n=12, 24.5%), national or regional approaches (n=13, 26.5%) and one topic-specific methodology. From the key adaptation steps of the identified approaches, we found that ‘judging quality of evidence’ and ‘establishing guideline group processes’ were the least addressed. Approximately 20% of applications modified the original approaches during the adaptation process. ADAPTE (n=50, 33.1%) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT (n=41, 27.2%) are the most commonly used adaptation approaches. Also, over half of the identified applications were adapted at the evidence level (n=88, 58.3%) and completed the process within 12 months (range: 2–36 months). Conclusions: 49 adaptation approaches were identified, with a recent surge in interest and utilisation. Although adaptation can save time and resources, substantial variations among existing approaches and their applications remain. These findings highlight the need for comprehensive guidance to support standardisation and optimise the quality of the adaptation process.

Background: Evidence-informed public health decision-making (EIDM) is a complex process that must consider multiple factors. Aim: We aimed to identify and describe existing frameworks supporting evidence-informed public health decision-making and their application to infectious disease. Methods: We conducted a scoping review to describe current EIDM framework use in public health. We included decision-making frameworks in public health and examples of their use in infectious diseases. We searched MEDLINE and Health Systems Evidence from inception to December 2022. We also hand searched websites of relevant organisations and conducted a forward citation search of the included frameworks. Two reviewers selected studies independently, one reviewer extracted data and one cross-checked for accuracy. We presented the results narratively. Results: We included 15 frameworks. Seven had a generic scope and eight were focused on specific topics (immunisation, COVID-19 or other, non-infectious diseases). From the included frameworks, we identified a total of 18 criteria with each framework assessing a median of eight, the most frequent being ‘desirable effects’, ‘resources considerations’ and ‘feasibility’. We identified infectious disease examples for four frameworks: ‘Grading of Recommendations, Assessment, Development, and Evaluation’ (GRADE), WHO-INTEGRATe Evidence (WHO-INTEGRATE), ‘Ethics, Equity, Feasibility, and Acceptability’ (EEFA) and ‘Community Preventive Services Task Force’ (CPSTF) evidence-to-decision frameworks. Conclusion: Although several EIDM frameworks exist for public health decision-making, most have not been widely applied to infectious diseases. Current EIDM frameworks inconsistently address factors for public health decision-making. Further application and evaluation, and possibly adaptation of existing frameworks, is required to optimise decision-making in public health and infectious diseases.

Background: Evidence-informed decision-making in public health (PH) is a complex process requiring the consideration of multiple perspectives and contextual factors. Evidence-to-decision (EtD) frameworks are structured approaches aiming to improve decision-making by considering critical criteria, but users’ experience has not been systematically synthesised. Aim: We aim to summarise users’ experiences of EtD frameworks used for PH. Methods: As part of a broader scoping review, we identified 15 EtD frameworks for PH decision-making. We searched MEDLINE and Health Systems Evidence, conducted a hand search and citation search strategy for documents reporting users’ experience of EtD frameworks and surveyed key stakeholders. We conducted a descriptive thematic synthesis, identifying main barriers and facilitators, complementing with surveys to relevant stakeholders. Results: We identified 12 studies reporting users’ experience of two EtD frameworks: Grading of Recommendations Assessment, Development and Evaluation (n = 9) and World Health Organization INTEGRATe Evidence (n = 3). Both were perceived as structured approaches that enhanced the use of evidence while including contextual factors and facilitating consensus-building processes. Main barriers were lack of high-quality evidence for the effectiveness of PH interventions, limitations of the terminology or unclear boundaries between specific criteria, perceptions of missing criteria and the need for more guidance. Survey responses (n = 13) were consistent with these findings. Conclusion: Users of the two frameworks had an overall positive perception of the approaches, but several barriers remain. These experiences may change over time as the frameworks evolve. There is an evidence gap regarding users’ experience for other EtD frameworks.

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 development checklist (GDC) extension for guideline adaptation.Methods: This project follows multiphase iterative approach, including (1) compiling a list of key methodological steps for guideline adaptation, based on scoping reviews of the current knowledge of guideline adaptation; (2) proposing methodological principles for guideline adaptation based on key methodological steps, in parallel to developing the GIN‐McMaster Guideline Development Checklist extension for adaptation (GDC‐adaptation extension) concerning the original checklist and methodological steps for adaptation; (3) iteratively refining the methodological steps through GIN Adaptation working group discussions, and GDC‐adaptation extension items through several rounds of Delphi consensus survey and (4) Public consultation and finalization. For methodological principles, this involves public consultation; for GDC‐adaptation extension, we will conduct user testing through semi‐structured interviews. Finally, we will submit the final outputs to the GIN board and seek final approval.Discussion: The identification of the key methodological principles, together with the GIN‐McMaster GDC extension for guideline adaptation and contextualization, will provide clarity in the planning and execution of adaptation, adoption and/or development of recommendations. The aim of the checklist is to improve efficiency and reduce research waste in guideline development while maintaining rigour and transparency.

Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms ‘self-management’, ‘adult’ and ‘T2DM’ for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10–14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care.

BackgroundEvidence-to-Decision (EtD) frameworks enable to consider critical criteria for decision-making. EtD frameworks with a public health perspective have not been systematically evaluated, and their application in the infectious diseases field remains unclear.ObjectiveTo identify and describe the existing EtD frameworks from a public health perspective, and to describe examples and experiences of their current application in the infectious diseases field.Methods:We will conduct a scoping review adhering to Joanna Briggs Institute methodological guidance, and PRISMA-ScR reporting guidance. We will include documents describing EtD frameworks (a structured process supporting panels to move from the evidence to a decision) from a public health perspective (aiming to make decisions at a health system or public health level on behalf of a population). We will also include representative examples and experiences of use of these frameworks in the infectious diseases field.We will search for documents in MEDLINE and Health System Evidence (2013-2023). We will also conduct manual searches in 60 key institutions’ websites, forward and backward citation search from the included frameworks, and surveys/interviews with key stakeholders. Two reviewers will conduct the selection and data extraction process. We will describe the scope of the frameworks, target audience and setting, categories of decisions, methods for development, definition of ‘evidence’, and decision making criteria.

Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. Conclusion: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. What is Known: • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. What is New: • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.