Sara Ibrahim

IntroductionDuring health emergencies, healthcare systems need timely and trustworthy evidence-based practice guidelines (EBPGs) to support decision-making regarding diagnostics, treatments, and prevention of diseases. The COVID-19 pandemic highlighted challenges in developing and implementing EBPGs under emergency conditions. This study aimed to identify the determinants that influenced the development and implementation of EBPGs during the COVID-19 pandemic.MethodologyWe conducted a qualitative descriptive study as the first phase of an exploratory sequential mixed-methods study. We generated data through individual, online, semi-structured interviews with a purposeful sample of guideline developers and implementers of COVID-19 EBPGs across four guideline developer roles and one implementer role. Using a team-based rapid qualitative analysis, we named and defined each determinant. We organized the determinants according to the Appraisal of Guidelines for Research & Evaluation (AGREE) II plus a Context domain for guideline developers, and the Consolidated Framework for Implementation Research (CFIR) 2.0 for guideline implementers. Reflexive discussion, data source and researcher triangulation, calibration, analytic meetings, and an audit trail supported methodological rigour.ResultsWe interviewed 47 participants across diverse roles, organizations, and genders; 68% of interviews were in English and 32% in Spanish. Guideline developers reported 52 determinants. We identified that most belonged to the Context domain (36.5%), followed by the AGREE-II domains Rigour of Development (23.1%) and Applicability (15.4%). Guideline implementers reported 43 determinants. We classified most under the Innovation (32.6%), Inner Setting (30.2%), and Outer Setting (18.6%) domains of the CFIR 2.0.ConclusionWe identified a broad range of determinants influencing EBPG development and implementation during the COVID-19 pandemic. These determinants will inform the development of a survey, which will assess their frequency and perceived impact on a larger sample of guideline developers and implementers.

This systematic review summarizes the evidence informing 2 recommendations from the updated American Society of Hematology guidelines for the treatment of newly diagnosed acute myeloid leukemia in older adults, comparing conventional induction and postremission therapy vs hypomethylating agents (HMA)- or low-dose cytarabine (LDAC)-based strategies, with or without venetoclax. We searched Ovid MEDLINE and Embase, and Cochrane CENTRAL through February 2024, and monitored these databases for new studies throughout November 2024. We included randomized controlled trials (RCTs) and nonrandomized studies (NRS). Reviewers screened studies, extracted data, assessed risk of bias, conducted random-effects meta-analyses, and rated certainty of evidence using GRADE (grading of recommendations, assessment, development, and evaluation). We included 21 studies (3 RCTs, 18 NRS). Compared with HMA- or LDAC-based monotherapy, conventional 7+3-type remission induction therapy may reduce mortality at longest follow-up (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.85-1.04; low certainty), increase complete remission rates (odds ratio, 1.75; 95% CI, 1.25-2.38; high certainty), and may reduce recurrence at longest follow-up (RR, 0.81; 95% CI, 0.64-1.04; low certainty). Conventional therapies probably increase most severe toxicities (moderate certainty). Compared with HMA or LDAC combined with venetoclax, very low certainty evidence suggests that conventional therapy may reduce 1-year mortality (RR, 0.72; 95% CI, 0.60-0.87), increase allogeneic transplant rates (RR, 2.28; 95% CI, 1.70-3.06), result in no important differences in complete remission or recurrence, and have variable effects on severe toxicities. Conventional therapy may have benefits over HMA or LDAC alone; however, compared with HMA or LDAC plus venetoclax, the evidence remains of very low certainty.

Older adults with newly diagnosed acute myeloid leukemia (AML) are often ineligible for conventional “7+3” induction chemotherapy. Despite recent drug approvals, treatment outcomes remain poor in this population. We conducted an updated systematic review to inform the 2025 American Society of Hematology (ASH) AML update guidelines in older adults. This review compared the efficacy and safety of low-dose cytarabine (LDAC), azacitidine (AZA), 5- and 10-day decitabine (DEC), and gemtuzumab ozogamicin, alone or combined with drugs such as venetoclax (VEN), in older adults with AML ineligible for conventional chemotherapy. We included randomized controlled trials (RCTs) and nonrandomized studies (NRSs) of adults aged ≥55 years with AML, and synthesized evidence on mortality, remission, quality of life (QoL), functional status, and severe toxicity. We applied GRADE (grading of recommendations assessment, development, and evaluation) to assess the certainty of evidence. We included 47 studies (30 RCTs and 17 NRSs). AZA or LDAC combined with VEN probably reduces mortality and improves remission and QoL. AZA plus isocitrate dehydrogenase 1 (IDH1) inhibitors may reduce 1-year mortality and improve remission and survival in patients with IDH1-mutated AML. Compared with DEC alone, combining DEC with other agents showed inconsistent effects with mostly low certainty of conclusions. VEN combinations showed promising effects on mortality and remission but lacked data on QoL and functional status. In older adults with AML ineligible for conventional therapy, evidence suggests that hypomethylating agents or LDAC combined with VEN likely improves survival and remission outcomes. Treatment decisions should consider patient goals and functional status. These findings informed 8 recommendations in updated ASH-AML guidelines.

Introduction: Guideline development is both time-consuming and resource-intensive, and duplication of efforts contribute to research waste. Although adopting existing guidelines is an efficient alternative, it often fails to account for contextual factors. Adapting trustworthy, previously developed relevant guidelines offers a promising alternative. Thus, we aimed to identify, describe and evaluate formal frameworks for the adaptation of health-related guidelines.Methods: We updated a previously published systematic survey of guideline adaptation frameworks by searching MEDLINE (Ovid) and Embase (Ovid) from January 1st, 2015, to October 31st, 2025. Eligible studies described an adaptation framework for health guidelines in sufficient detail to allow reproducibility. We excluded reviews, guideline adaptations, and implementation reports. We extracted in duplicate and independently data on framework characteristics and presented results in both narrative and tabular formats.Results: Our search identified 20 guideline adaptation frameworks, up from eight identified in the previous survey. These frameworks included five to 24 steps (median: 13). Each framework followed one of four primary approaches: ADAPTE-based (6/20); GRADE-ADOLOPMENT-based (3/20); hybrid approaches (2/20); and non-systematic approaches (9/20). ADAPTE-based frameworks follow a comprehensive three-phase, 24-step process to assess and modify entire source guidelines. In contrast, GRADE-ADOLOPMENT-based frameworks focus on recommendation-level contextualization using evidence-to-decision frameworks. The remaining frameworks primarily utilize non-systematic methods. The most frequently reported challenges were high resource and expertise requirements, dependence on the quality and availability of source guidelines, contextual and implementation barriers, and limited capacity for new evidence synthesis.Discussion: Guideline adaptation frameworks vary substantially in scope and methods, reflecting a balance between methodological rigor and feasibility. ADAPTE- and GRADE- ADOLOPMENT-based approaches provide structured methods, while more recent frameworks prioritize flexibility. This synthesis will help guideline developers select approaches that best fit their context and resources.

Background: Older adults with acute myeloid leukemia (AML) represent a cancer population in which disease-based risk factors, comorbidities, patient goals, and treatment risks and benefits influence treatment recommendations. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health professionals in their decisions about management of AML in older adults. Methods: ASH formed a multidisciplinary guideline panel, including patient representatives, that minimized bias from conflicts of interest. Clarity Research Group at McMaster University supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized questions and outcomes according to their importance for clinicians and patients. The panel used the grading of recommendations assessment, development and evaluation approach, including evidence-to-decision frameworks, to assess evidence and make recommendations. Results: The panel agreed on 9 critical clinical recommendations for managing AML in older adults, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management; traditional induction and postremission therapy vs hypomethylating agent or low-dose cytarabine, or combinations with venetoclax; the role and duration of postremission therapy; combinations with venetoclax vs monotherapy; the use of targeted therapy, including isocitrate dehydrogenase and FMS-like tyrosine kinase 3 (FLT3) inhibitors, in appropriate patients; the role of hematopoietic stem cell transplantation in nonfavorable prognosis AML; and the role of transfusion support for patients no longer receiving antileukemic therapy. Conclusions: Key recommendations of these guidelines include treatment over best supportive care; venetoclax-based regimens over monotherapies; and incorporation of FLT3 inhibitors into traditional induction and postremission therapy.

Introduction: Antimicrobial resistance (AMR) is a widely recognized threat to global health, mainly driven by the inappropriate use of antimicrobials. Recommendations from evidence‐based practice guidelines (EBPGs) can promote appropriate antimicrobial use. Currently, no guidance exists for considering AMR in EBPGs. This is the protocol for two studies that aim to (1) develop a checklist of AMR considerations for EBPGs and (2) conduct a case study to evaluate existing EBPGs regarding the extent to which AMR is considered among other methodological assessments. Methods: Using the Delphi technique, we will consult with individuals from four interest‐holder groups to develop and refine a checklist of AMR considerations for EBPGs. To assess EBPGs, we will search various databases for guidelines on four prioritized syndromes (i.e., community‐acquired pneumonia, urinary tract infection, skin and soft tissue infections and exacerbations of chronic obstructive pulmonary disease). We will screen articles in duplicate and in stages to include EBPGs for the prioritized syndromes and will use piloted data extraction forms to extract characteristics of the EBPGs. For each EBPG, we will evaluate whether AMR was considered (using the developed checklist), its trustworthiness (i.e., methodological quality) (using the modified National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards instrument) and its adaptability (using items from existing adaptability frameworks). Discussion: This work will develop a checklist of AMR considerations for EBPGs and evaluate a subsequent sample of EBPGs to investigate the extent to which AMR is considered. Furthermore, by conducting a methodological appraisal of trustworthiness and adaptability, this study will contextualize results to promote the uptake and appropriate interpretation of existing guidelines. Thus, these findings will be useful to decision‐makers as well as guideline development groups as they highlight what existing work can be trusted and leveraged while also identifying what limitations and gaps need to be addressed.