Per Olav Vandvik

• Rustad Indregard, Anne Marthe; Nussle, Hans Martin; Småstuen, Milada Cvancarova; Vandvik, Per Olav; Tesli, Martin Steen & Gather, Jakov [Show all 7 contributors for this article] (2024). Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway. The Lancet Psychiatry. ISSN 2215-0374. doi: 10.1016/S2215-0366(24)00039-7.
• Mthethwa, Mashudu; Mbeye, Nyanyiwe Masingi; Effa, Emmanuel; Arikpo, Dachi; Blose, Ntombifuthi & Brand, Amanda [Show all 21 contributors for this article] (2024). Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review. BMC Health Services Research. ISSN 1472-6963. 24(1). doi: 10.1186/s12913-024-10682-0.
• Busse, Jason W.; Casassus, Rodrigo; Carrasco-Labra, Alonso; Durham, Justin; Mock, David & Zakrzewska, Joanna M. [Show all 20 contributors for this article] (2023). Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. The BMJ. ISSN 1756-1833. 383. doi: 10.1136/bmj-2023-076227.
• Hunskaar, Birk Bårdson Stokke; Løvsletten, Per Olav; Muller, Ashley & Vandvik, Per Olav (2023). Interpretation and use of a decision support tool for multiple treatment options: A combined randomised controlled trial and survey of medical students. BMJ Evidence-Based Medicine. ISSN 2515-446X. doi: 10.1136/bmjebm-2023-112370. Full text in Research Archive
• Alme, Tomas Nordheim; Andreasson, Anna; Asprusten, Tarjei Tørre; Bakken, Anne Karen; Beadsworth, Michael BJ & Boye, Birgitte [Show all 51 contributors for this article] (2023). Chronic fatigue syndromes: real illnesses that people can recover from. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), p. 372–376. doi: 10.1080/02813432.2023.2235609. Full text in Research Archive Show summary

  The ‘Oslo Chronic Fatigue Consortium’ consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

• Hassan, Cesare; Spadaccini, Marco; Mori, Yuichi; Foroutan, Farid; Facciorusso, Antonio & Gkolfakis, Paraskevas [Show all 23 contributors for this article] (2023). Real-Time Computer-Aided Detection of Colorectal Neoplasia During Colonoscopy : A Systematic Review and Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. 176(9), p. 1209–1220. doi: 10.7326/M22-3678.
• Zeng, Linan; Helsingen, Lise Mørkved; Bretthauer, Michael; Agoritsas, Thomas; Vandvik, Per Olav & Mustafa, Reem A. [Show all 15 contributors for this article] (2023). A novel framework for incorporating patient values and preferences in making guideline recommendations: guideline panel surveys. Journal of Clinical Epidemiology. ISSN 0895-4356. doi: 10.1016/j.jclinepi.2023.07.003.
• Zeng, Linan; Li, Shelly-Anne; Yang, Mengting; Yan, Lijiao; Helsingen, Lise Mørkved & Bretthauer, Michael [Show all 15 contributors for this article] (2023). Qualitative study of guideline panelists: innovative surveys provided valuable insights regarding patient values and preferences. Journal of Clinical Epidemiology. ISSN 0895-4356. doi: 10.1016/j.jclinepi.2023.07.014.
• Shi, Qingyang; Nong, Kailei; Vandvik, Per Olav; Guyatt, Gordon H.; Schnell, Oliver & Rydén, Lars [Show all 40 contributors for this article] (2023). Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. The BMJ. ISSN 1756-1833. 381. doi: 10.1136/bmj-2022-074068.
• Wang, Yang; Zhang, Shipeng; Du, Heyue; Li, Jing; Khan, Safi U. & Aertgeerts, Bert [Show all 16 contributors for this article] (2023). Safety of ezetimibe in lipid-lowering treatment: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ Medicine. ISSN 2754-0413. 1(1). doi: 10.1136/bmjmed-2022-000134. Show summary

  Objective: To determine the harms of ezetimibe in people who need lipid-lowering treatment. Design: Systematic review and meta-analysis. Data sources: Randomised controlled trials and cohort studies. Eligibility criteria for selecting studies: Studies comparing ezetimibe with placebo, standard care, or other lipid-lowering agents in people who need lipid-lowering treatment with a follow-up duration of at least six months (or 24 weeks). The relative effects for potential harms of ezetimibe were pooled by use of random effect pairwise meta-analyses for randomised controlled trials and the evidence from observational studies was narratively summarised. The certainty of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation. Results: 48 randomised controlled trials with 28 444 participants (median follow-up 34 weeks, range 24-312 weeks) and four observational studies with 1667 participants (median follow-up 282 weeks, range 72-400 weeks) were included. The meta-analyses of randomised trials showed moderate to high certainty that ezetimibe was not associated with cancer (relative risk 1.01; 95% confidence interval 0.92 to 1.11), fractures (0.90; 0.74 to 1.10), discontinuation due to any adverse event (0.87; 0.74 to 1.03), gastrointestinal adverse events leading to discontinuation (1.34; 0.58 to 3.08), myalgia or muscular pain leading to discontinuation (0.82; 0.51 to 1.33), neurocognitive events (1.48; 0.58 to 3.81), or new-onset diabetes (0.88; 0.61 to 1.28). The narrative analysis of observational studies provided consistent findings. No credible subgroup effects were identified for the harm outcomes, including shorter versus longer follow-up duration of trials. Conclusions: Ezetimibe results in little to no difference in adverse events or other undesirable effects compared with placebo, usual care or other lipid-lowering agents. Review registration: PROSPERO CRD42020187437. Keywords: Coronary disease; Pharmacology.

• Zeraatkar, Dena; Cusano, Ellen; Martinez, Juan PD; Qasim, Anila; Mangala, Sophia & Kum, Elena [Show all 17 contributors for this article] (2022). Use of tocilizumab and sarilumab alone or in combination with corticosteroids for covid-19: systematic review and network meta-analysis. BMJ Medicine. ISSN 2754-0413. 1(1). doi: 10.1136/bmjmed-2021-000036. Full text in Research Archive
• Milone, Marco; Adamina, Michel; Arezzo, Alberto; Bejinariu, Nona; Boni, Luigi & Bouvy, Nicole [Show all 17 contributors for this article] (2022). UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer. Surgical Endoscopy. ISSN 0930-2794. 36(4), p. 2221–2232. doi: 10.1007/s00464-022-09090-4.
• Izcovich, Ariel; Siemieniuk, Reed Alexander; Bartoszko, Jessica Julia; Ge, Long; Zeraatka, Dena & Kum, Elena [Show all 15 contributors for this article] (2022). Adverse effects of remdesivir, hydroxychloroquine and lopinavir/ritonavir when used for COVID-19: systematic review and meta-analysis of randomised trials. BMJ Open. ISSN 2044-6055. 12(3). doi: 10.1136/bmjopen-2020-048502..
• Owen, Andrew; Diaz, Janet Victoria; Gyatt, Gordon; Lamontagne, Francis; Stegemann, Miriam & Vandvik, Per Olav [Show all 7 contributors for this article] (2022). WHO Living Guidelines on antivirals for COVID-19 are evidence-based. The Lancet. ISSN 0140-6736. 400(10369), p. 2196–2198. doi: 10.1016/S0140-6736(22)02306-6.
• Khan, Safi U; Yedlapati, Siva H; Lone, Ahmad N; Hao, Qiukui; Guyatt, Gordon & Delvaux, Nicolas [Show all 12 contributors for this article] (2022). PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: A systematic review and network meta-analysis. The BMJ. ISSN 1756-1833. 2022(377). doi: 10.1136/bmj-2021-069116.
• Hao, Qiukui; Aertgeerts, Bert; Guyatt, Gordon; Bekkering, Geertruida E; Vandvik, Per Olav & Khan, Safi U [Show all 27 contributors for this article] (2022). PCSK9 inhibitors and ezetimibe for the reduction of cardiovascular events: A clinical practice guideline with risk-stratified recommendations. The BMJ. ISSN 1756-1833. 2022(377). doi: 10.1136/bmj-2021-069066.
• McCaul, Michael; Tovey, David; Young, Taryn; Welch, Vivian; Dewidar, Omar & Goetghebeur, Mireille [Show all 15 contributors for this article] (2022). Resources supporting trustworthy, rapid and equitable evidence synthesis and guideline development: results from the COVID-19 evidence network to support decision-making (COVID-END). Journal of Clinical Epidemiology. ISSN 0895-4356. 151, p. 88–95. doi: 10.1016/j.jclinepi.2022.07.008.
• Zou, Xinyu; Shi, Qingyang; Vandvik, Per Olav; Guyatt, Gordon; Lang, Chim C. & Parpia, Sameer [Show all 13 contributors for this article] (2022). Sodium–Glucose Cotransporter-2 Inhibitors in Patients With Heart Failure A Systematic Review and Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. 175(6), p. 851–861. doi: 10.7326/M21-4284.
• Li, Jing; Du, Heyue; Wang, Yang; Aertgeerts, Bert; Guyatt, Gordon & Hao, Qiukui [Show all 17 contributors for this article] (2022). Safety of proprotein convertase subtilisin/kexin 9 inhibitors: A systematic review and meta-analysis. Heart. ISSN 1355-6037. 18(16). doi: 10.1136/heartjnl-2021-320556.
• Zeng, Linan; Walsh, Michael; Guyatt, Gordon H; Siemieniuk, Reed A C; Collister, David & Booth, Michelle [Show all 22 contributors for this article] (2022). Plasma exchange and glucocorticoid dosing for patients with ANCA-associated vasculitis: A clinical practice guideline. The BMJ. ISSN 1756-1833. doi: 10.1136/bmj-2021-064597.
• O'Connor, Denise; Johnston, Renea V; Brignardello-Petersen, Romina; Poolman, Rudolf W; Cyril, Sheila & Vandvik, Per Olav [Show all 7 contributors for this article] (2022). Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database of Systematic Reviews. ISSN 1469-493X. 2022(3), p. 1–158. doi: 10.1002/14651858.CD014328.
• Carrano, Francesco M.; Iossa, Angelo; Di Lorenzo, Nicola; Silecchia, Gianfranco; Kontouli, Katerina-Maria & Mavridis, Dimitris [Show all 38 contributors for this article] (2022). EAES rapid guideline: systematic review, network meta-analysis, CINeMA and GRADE assessment, and European consensus on bariatric surgery–extension 2022. Surgical Endoscopy. ISSN 0930-2794. 36, p. 1709–1725. doi: 10.1007/s00464-022-09008-0.
• Riaz, Irbaz Bin; Fuentes, Harry E.; Naqvi, Syed Arsalan Ahmed; Huan, He; Sipra, Qurat-Ul-Ain Riaz & Tafur, Alfonso J. [Show all 16 contributors for this article] (2022). Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis. Mayo Clinic proceedings. ISSN 0025-6196. 97(2), p. 308–324. doi: 10.1016/j.mayocp.2020.10.041. Show summary

  Objective: To maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT). Methods: We have used a novel LIvE synthesis framework to maintain this living, interactive systematic review since September 19, 2018. Randomized controlled trials evaluating the efficacy and safety of direct oral anticoagulants (DOACs) compared with low-molecular-weight heparin for CAT are included in this analysis. Details of LIvE synthesis framework are available at the website https://cat.network-meta-analysis.com. Results: The results are constantly updated as new information becomes available (https://cat.network-meta-analysis.com/CAT.html). The living, interactive systematic review currently includes 4 randomized controlled trials (N=2894). Direct comparisons show that DOACs significantly decrease recurrent venous thromboembolism (VTE) events compared with dalteparin (odds ratio [OR], 0.59; 95% CI, 0.41 to 0.86; I2, 25%) without significantly increasing major bleeding (OR, 1.34; 95% CI, 0.83 to 2.18; I2, 28%). Mixed treatment comparisons show that apixaban (OR, 0.41; 95% credible interval [CrI], 0.16 to 0.95) and rivaroxaban (OR, 0.58; 95% CrI, 0.37 to 0.90) significantly decrease VTE recurrent events compared with dalteparin. Edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73; 95% CrI, 1.04 to 3.16), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs. There are no significant differences between DOACs in terms of VTE recurrences and major bleeding. Conclusion: DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favors the use of apixaban for the treatment of CAT among other DOACs. Registration: Open Science Framework (https://osf.io/dth86). Trial registration: ClinicalTrials.gov NCT02744092 NCT02746185 NCT03139487 NCT02583191. Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

• Bartoszko, Jessica; Siemieniuk, Reed A.C.; Kum, Elena; Qasim, Anila; Zeraatkar, Dena & Ge, Long [Show all 40 contributors for this article] (2021). Prophylaxis against covid-19: Living systematic review and network meta-analysis. BMJ. British Medical Journal. ISSN 0959-8146. 373, p. 1–19. doi: 10.1136/bmj.n949.
• Honarmand, Kimia; Penn, Jeremy; Agarwal, Arnav; Siemieniuk, Reed A.C.; Brignardello-Petersen, Romina & Bartoszko, Jessica [Show all 19 contributors for this article] (2021). Clinical trials in COVID-19 management & prevention: A meta-epidemiological study examining methodological quality. Journal of Clinical Epidemiology. ISSN 0895-4356. 139, p. 68–79. doi: 10.1016/j.jclinepi.2021.07.002.
• Marx, Nikolaus; Ryden, Lars; Brosius, Frank; Ceriello, Antonio; Cheung, Michael & Cosentino, Francesco [Show all 17 contributors for this article] (2021). Towards living guidelines on cardiorenal outcomes in diabetes: A pilot project of the Taskforce of the Guideline Workshop 2020. Diabetes Research and Clinical Practice. ISSN 0168-8227. 177, p. 108870–108870. doi: 10.1016/j.diabres.2021.108870.
• Vandvik, Per Olav; González-González, José Gerardo; Díaz González-Colmenero, Alejandro; Millán-Alanís, Juan Manuel; Lytvyn, Lyubov & Solis, Ricardo Cesar [Show all 12 contributors for this article] (2021). Values, preferences and burden of treatment for the initiation of GLP-1 receptor agonists and SGLT-2 inhibitors in adult patients with type 2 diabetes: a systematic review. BMJ Open. ISSN 2044-6055. 11(7), p. e049130–-e049130. doi: 10.1136/bmjopen-2021-049130.
• Shi, Q; Wang, Y; Hao, Qiukui; Vandvik, Per Olav; Guyatt, Gordon & Li, J [Show all 27 contributors for this article] (2021). Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. The Lancet. ISSN 0140-6736. 399(10321), p. 259–269. doi: 10.1016/S0140-6736(21)01640-8.
• Riaz, Irbaz Bin; He, Huan; Ryu, Alexander J.; Siddiqi, Rabbia; Naqvi, Syed Arsalan Ahmed & Yao, Yuan [Show all 22 contributors for this article] (2021). A Living, Interactive Systematic Review and Network Meta-analysis of First-line Treatment of Metastatic Renal Cell Carcinoma[Formula presented]. European Urology. ISSN 0302-2838. 80(6), p. 712–723. doi: 10.1016/j.eururo.2021.03.016.
• Buchan, Tayler A.; Malik, Abdullah; Chan, Cynthia; Chambers, Jason; Suk, Yujin & Zhu, Jie Wei [Show all 15 contributors for this article] (2021). Predictive models for cardiovascular and kidney outcomes in patients with type 2 diabetes: Systematic review and meta-analyses. Heart. ISSN 1355-6037. 107(24), p. 1962–1973. doi: 10.1136/heartjnl-2021-319243.
• Li, Sheyu; Vandvik, Per Olav; Lytvyn, Lyubov; Guyatt, Gordon; Palmer, Suetonia C. & Rodriguez-Gutierrez, René [Show all 28 contributors for this article] (2021). SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: A clinical practice guideline. The BMJ. ISSN 1756-1833. 373. doi: 10.1136/bmj.n1091. Show summary

  Clinical question: What are the benefits and harms of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists when added to usual care (lifestyle interventions and/or other diabetes drugs) in adults with type 2 diabetes at different risk for cardiovascular and kidney outcomes? Current practice: Clinical decisions about treatment of type 2 diabetes have been led by glycaemic control for decades. SGLT-2 inhibitors and GLP-1 receptor agonists are traditionally used in people with elevated glucose level after metformin treatment. This has changed through trials demonstrating atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) benefits independent of medications' glucose-lowering potential. Recommendations: The guideline panel issued risk-stratified recommendations concerning the use of SGLT-2 inhibitors or GLP-1 receptor agonists in adults with type 2 diabetes• Three or fewer cardiovascular risk factors without established CVD or CKD: Weak recommendation against starting SGLT-2 inhibitors or GLP-1 receptor agonists.• More than three cardiovascular risk factors without established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and weak against starting GLP-1 receptor agonists.• Established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and GLP-1 receptor agonists.• Established CVD and CKD: Strong recommendation for starting SGLT-2 inhibitors and weak recommendation for starting GLP-1 receptor agonists.• For those committed to further reducing their risk for CVD and CKD outcomes: Weak recommendation for starting SGLT-2 inhibitors rather than GLP-1 receptor agonists. How this guideline was created: An international panel including patients, clinicians, and methodologists created these recommendations following standards for trustworthy guidelines and using the GRADE approach. The panel applied an individual patient perspective. The evidence: A linked systematic review and network meta-analysis (764 randomised trials included 421 346 participants) of benefits and harms found that SGLT-2 inhibitors and GLP-1 receptor agonists generally reduce overall death, and incidence of myocardial infarctions, and end-stage kidney disease or kidney failure (moderate to high certainty evidence). These medications exert different effects on stroke, hospitalisations for heart failure, and key adverse events in different subgroups. Absolute effects of benefit varied widely based on patients' individual risk (for example, from five fewer deaths in the lowest risk to 48 fewer deaths in the highest risk, for 1000 patients treated over five years). A prognosis review identified 14 eligible risk prediction models, one of which (RECODe) informed most baseline risk estimates in evidence summaries to underpin the risk-stratified recommendations. Concerning patients' values and preferences, the recommendations were supported by evidence from a systematic review of published literature, a patient focus group study, a practical issues summary, and a guideline panel survey.

• Siemieniuk, Reed A.C.; Bartoszko, Jessica J; Díaz Martinez, Juan Pablo; Kum, Elena; Qasim, Anila & Zeraatkar, Dena [Show all 36 contributors for this article] (2021). Antibody and cellular therapies for treatment of covid-19: A living systematic review and network meta-analysis. The BMJ. ISSN 1756-1833. 374, p. 2231–2231. doi: 10.1136/bmj.n2231.
• Busse, Jason W.; Vankrunkelsven, Patrick; Zeng, Linan; Heen, Anja Fog; Merglen, Arnaud & Campbell, Fiona [Show all 22 contributors for this article] (2021). Medical cannabis or cannabinoids for chronic pain: A clinical practice guideline. The BMJ. ISSN 1756-1833. 374. doi: 10.1136/bmj.n2040. Show summary

  Abstract Clinical question: What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer or non-cancer causes? Current practice: Chronic pain is common and distressing and associated with considerable socioeconomic burden globally. Medical cannabis is increasingly used to manage chronic pain, particularly in jurisdictions that have enacted policies to reduce use of opioids; however, existing guideline recommendations are inconsistent, and cannabis remains illegal for therapeutic use in many countries. Recommendation: The guideline expert panel issued a weak recommendation to offer a trial of non-inhaled medical cannabis or cannabinoids, in addition to standard care and management (if not sufficient), for people living with chronic cancer or non-cancer pain. How this guideline was created: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel applied an individual patient perspective. The evidence: This recommendation is informed by a linked series of four systematic reviews summarising the current body of evidence for benefits and harms, as well as patient values and preferences, regarding medical cannabis or cannabinoids for chronic pain. Understanding the recommendation: The recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain. It reflects a high value placed on small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self limited and transient harms. Shared decision making is required to ensure patients make choices that reflect their values and personal context. Further research is warranted and may alter this recommendation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

• Antoniou, Stavros A.; Mavridis, Dimitris; Kontouli, Katerina Maria; Drakopoulos, Vasileios; Gorter-Stam, Marguerite & Eriksson, Sture [Show all 13 contributors for this article] (2021). EAES rapid guideline: appendicitis in the elderly. Surgical Endoscopy. ISSN 0930-2794. 35(7), p. 3233–3243. doi: 10.1007/s00464-021-08524-9.
• Heen, Anja Fog; Vandvik, Per Olav; Brandt, Linn; Achille, Frankie; Guyatt, Gordon Henry & Akl, Elie A. [Show all 8 contributors for this article] (2021). Decision aids linked to evidence summaries and clinical practice guidelines: results from user-testing in clinical encounters. BMC Medical Informatics and Decision Making. ISSN 1472-6947. 21, p. 1–15. doi: 10.1186/s12911-021-01541-7. Full text in Research Archive Show summary

  Abstract Background: Tools for shared decision-making (e.g. decision aids) are intended to support health care professionals and patients engaged in clinical encounters involving shared decision-making. However, decision aids are hard to produce, and onerous to update. Consequently, they often do not refect best current evidence, and show limited uptake in practice. In response, we initiated the Sharing Evidence to Inform Treatment decisions (SHARE-IT) project. Our goal was to develop and refne a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries. Methods: Applying principles of human-centred design and following the International Patient Decision Aid Standards (IPDAS) and GRADE methods for trustworthy evidence summaries we developed a decision aid prototype in collaboration with the Developing and Evaluating Communication strategies to support Informed Decisions and practice based on Evidence project (DECIDE). We iteratively user-tested the prototype in clinical consultations between clinicians and patients. Semi-structured interviews of participating clinicians and patients were conducted. Qualitative content analysis of both user-testing sessions and interviews was performed and results categorized according to a revised Morville’s framework of user-experience. We made it possible to produce, publish and use these decision aids in an electronic guideline authoring and publication platform (MAGICapp). Results: Direct observations and analysis of user-testing of 28 clinical consultations between physicians and patients informed four major iterations that addressed readability, understandability, usability and ways to cope with information overload. Participants reported that the tool supported natural fow of the conversation and induced a positive shift in consultation habits towards shared decision-making. We integrated the functionality of SHARE-IT decision aids in MAGICapp, which has since generated numerous decision aids. Conclusion: Our study provides a proof of concept that encounter decision aids can be generically produced from GRADE evidence summaries and clinical guidelines. Online authoring and publication platforms can help scale up production including continuous updating of electronic encounter decision aids, fully integrated with evidence summaries and clinical practice guidelines. Keywords: Decision aids, Shared decision-making, Clinical practice guidelines.

• Lamontagne, Francois; Agoritsas, Thomas; Siemieniuk, Reed A.C.; Rochwerg, Bram; Bartoszko, Jessica & Askie, Lisa [Show all 53 contributors for this article] (2021). A living WHO guideline on drugs to prevent covid-19. The BMJ. ISSN 1756-1833. doi: 10.1136/bmj.n526.
• Palmer, Suetonia C.; Tendal, Britta; Mustafa, Reem A.; Vandvik, Per Olav; Li, Sheyu & Hao, Qiukui [Show all 44 contributors for this article] (2021). Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: Systematic review and network meta-analysis of randomised controlled trials. BMJ. British Medical Journal. ISSN 0959-8146. 372, p. 1–14. doi: 10.1136/bmj.m4573.
• Heen, Anja Fog; Lytvyn, Lyubov; Shapiro, Michael; Guyatt, Gordon; Siemieniuk, Reed Alexander Cunningham & Zhang, Yuan [Show all 9 contributors for this article] (2021). Patient values and preferences on valve replacement for aortic stenosis: A systematic review. Heart. ISSN 1355-6037. p. 1–7. doi: 10.1136/heartjnl-2020-318334. Full text in Research Archive Show summary

  Abstract The review aims to summarise evidence addressing patients’ values, preferences and practical issues on deciding between transcatheter aortic valve insertion (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. We searched databases and grey literature until June 2020. We included studies of adults with aortic stenosis eliciting values and preferences about treatment, excluding medical management or palliative care. Qualitative findings were synthesised using thematic analysis, and quantitative findings were narratively described. Evidence certainty was assessed using CERQual (Confidence in the Evidence from Reviews of Qualitative Research) and GRADE (Grading of Recommendations Assessment, Development and Evaluation). We included eight studies. Findings ranged from low to very low certainty. Most studies only addressed TAVI. Studies addressing both TAVI and SAVR reported on factors affecting patients’ decision-making along with treatment effectiveness, instead of trade-offs between procedures. Willingness to accept risk varied considerably. To improve their health status, participants were willing to accept higher mortality risk than current evidence suggests for either procedure. No study explicitly addressed valve reintervention, and one study reported variability in willingness to accept shorter duration of known effectiveness of TAVI compared with SAVR. The most common themes were desire for symptom relief and improved function. Participants preferred minimally invasive procedures with shorter hospital stay and recovery. The current body of evidence on patients’ values, preferences and practical issues related to aortic stenosis management is of suboptimal rigour and reports widely disparate results regarding patients’ perceptions. These findings emphasise the need for higher quality studies to inform clinical practice guidelines and the central importance of shared decision-making to individualise care fitted to each patient.

• Naci, Huseyin; Kesselheim, Aaron S; Røttingen, John-Arne; Salanti, Georgia; Vandvik, Per Olav & Cipriani, Andrea (2020). Producing and using timely comparative evidence on drugs: Lessons from clinical trials for covid-19. BMJ. British Medical Journal. ISSN 0959-8146. 371:m3869, p. 1–6. doi: 10.1136/bmj.m3869.
• Foroutan, Farid; Guyatt, Gordon H.; Zuk, Victoria; Vandvik, Per Olav; Alba, Ana C. & Mustafa, Reem A. [Show all 17 contributors for this article] (2020). GRADE Guidelines 28: Use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with different absolute risks. Journal of Clinical Epidemiology. ISSN 0895-4356. 121, p. 62–70. doi: 10.1016/j.jclinepi.2019.12.023.
• Vandvik, Per Olav & Brandt, Linn (2020). Future of Evidence Ecosystem Series: Evidence ecosystems and learning health systems: why bother? Journal of Clinical Epidemiology. ISSN 0895-4356. 123, p. 166–170. doi: 10.1016/j.jclinepi.2020.02.008.
• Rochwerg, Bram; Agarwal, Arnav; Zeng, Linan; Leo, Yee-Sin; Appiah, John Adabie & Agoritsas, Thomas [Show all 27 contributors for this article] (2020). Remdesivir for severe covid-19: A clinical practice guideline. The BMJ. ISSN 1756-1833. 370. doi: 10.1136/bmj.m2924.
• Marx, Nikolaus; Rydén, Lars E.; Brosius, Frank; Ceriello, Antonio; Cheung, Michael & Cosentino, Francesco [Show all 15 contributors for this article] (2020). Proceedings of the Guideline Workshop 2019: Strategies for the Optimization of Guideline Processes in Diabetes, Cardiovascular Diseases, and Kidney Diseases. Diabetes Technology & Therapeutics. ISSN 1520-9156. 22(7), p. 546–552. doi: 10.1089/dia.2020.0086.
• Helsingen, Lise M.; Zeng, Linan; Siemieniuk, Reed A.C.; Lytvyn, Lyubov; Vandvik, Per Olav & Agoritsas, Thomas [Show all 8 contributors for this article] (2020). Establishing thresholds for important benefits considering the harms of screening interventions. BMJ Open. ISSN 2044-6055. 10:e037854(12), p. 1–9. doi: 10.1136/bmjopen-2020-037854.
• Heen, Anja Fog; Vandvik, Per Olav; Brandt, Linn; Montori, Victor M.; Lytvyn, Lyubov & Guyatt, Gordon [Show all 8 contributors for this article] (2020). A framework for practical issues was developed to inform shared decision-making tools and clinical guidelines. Journal of Clinical Epidemiology. ISSN 0895-4356. 129, p. 104–113. doi: 10.1016/j.jclinepi.2020.10.002. Show summary

  Objectives: The objective of the study was to develop and test feasibility of a framework of patient-important practical issues. Study design and setting: Guidelines and shared decision-making tools help facilitate discussions about patient-important outcomes of care alternatives, but typically ignore practical issues patients consider when implementing care into their daily routines. Using grounded theory, practical issues in the HealthTalk.org registry and in Option Grids were identified and categorized into a framework. We integrated the framework into the MAGIC authoring and publication platform and digitally structured authoring and publication platform and appraised its use in The BMJ Rapid Recommendations. Results: The framework included the following 15 categories: medication routine, tests and visits, procedure and device, recovery and adaptation, coordination of care, adverse effects, interactions and antidote, physical well-being, emotional well-being, pregnancy and nursing, costs and access, food and drinks, exercise and activities, social life and relationships, work and education, travel and driving. Implementation in 15 BMJ Rapid Recommendations added 283 issues to 35 recommendations. The most frequently used category was procedure and device, and the least frequent was social life and relationship. Conclusion: Adding practical issues systematically to evidence summaries is feasible and can inform guidelines and tools for shared decision-making. How this inclusion can improve patient-centered care remains to be determined. Keywords: Clinical practice guidelines; Decision aids; Patient experience; Patient-important outcomes; Shared decision-making tools. Copyright © 2020 The Authors

• Lamontagne, Francois; Agoritsas, Thomas; MacDonald, Helen; Leo, Yee-Sin; DIaz, Janet & Agarwal, Arnav [Show all 40 contributors for this article] (2020). A living WHO guideline on drugs for covid-19. The BMJ. ISSN 1756-1833. 370. doi: 10.1136/bmj.m3379.
• Siemieniuk, Reed A.C.; Bartoszko, Jessica J; Ge, Long; Zeraatkar, Dena; Izcovich, Ariel & Kum, Elena [Show all 53 contributors for this article] (2020). Drug treatments for covid-19: living systematic review and network meta-analysis. The BMJ. ISSN 1756-1833. 370. doi: 10.1136/bmj.m2980. Full text in Research Archive
• Wang, Ying; Ye, Zhikang; Ge, Long; Siemieniuk, Reed A.C.; Wang, Xin & Wang, Yingkai [Show all 14 contributors for this article] (2020). Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: Systematic review and network meta-analysis. The BMJ. ISSN 1756-1833. doi: 10.1136/bmj.l6744.
• Ye, Zhikang; Blaser, Annika Reintam; Lytvyn, Lyubov; Wang, Ying; Guyatt, Gordon & Mikita, J. Stephen [Show all 20 contributors for this article] (2020). Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline. BMJ (Clinical Research Edition). ISSN 0959-8138. 368, p. 1–17. Show summary

  Clinical question: What is the role of gastrointestinal bleeding prophylaxis (stress ulcer prophylaxis) in critically ill patients? This guideline was prompted by the publication of a new large randomised controlled trial. Current practice: Gastric acid suppression with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) is commonly done to prevent gastrointestinal bleeding in critically ill patients. Existing guidelines vary in their recommendations of which population to treat and which agent to use. Recommendations: This guideline panel makes a weak recommendation for using gastrointestinal bleeding prophylaxis in critically ill patients at high risk (>4%) of clinically important gastrointestinal bleeding, and a weak recommendation for not using prophylaxis in patients at lower risk of clinically important bleeding (≤4%). The panel identified risk categories based on evidence, with variable certainty regarding risk factors. The panel suggests using a PPI rather than a H2RA (weak recommendation) and recommends against using sucralfate (strong recommendation). How this guideline was created: A guideline panel including patients, clinicians, and methodologists produced these recommendations using standards for trustworthy guidelines and the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. A weak recommendation means that both options are reasonable. The evidence: The linked systematic review and network meta-analysis estimated the benefit and harm of these medications in 12 660 critically ill patients in 72 trials. Both PPIs and H2RAs reduce the risk of clinically important bleeding. The effect is larger in patients at higher bleeding risk (those with a coagulopathy, chronic liver disease, or receiving mechanical ventilation but not enteral nutrition or two or more of mechanical ventilation with enteral nutrition, acute kidney injury, sepsis, and shock) (moderate certainty). PPIs and H2RAs might increase the risk of pneumonia (low certainty). They probably do not have an effect on mortality (moderate certainty), length of hospital stay, or any other important outcomes. PPIs probably reduce the risk of bleeding more than H2RAs (moderate certainty). Understanding the recommendation: In most critically ill patients, the reduction in clinically important gastrointestinal bleeding from gastric acid suppressants is closely balanced with the possibility of pneumonia. Clinicians should consider individual patient values, risk of bleeding, and other factors such as medication availability when deciding whether to use gastrointestinal bleeding prophylaxis. Visual overviews provide the relative and absolute benefits and harms of the options in multilayered evidence summaries and decision aids available on MAGICapp. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

• Moynihan, Ray; Bero, Lisa; Hill, Sue; Johansson, Minna; Lexchin, Joel & MacDonald, Helen [Show all 16 contributors for this article] (2020). Pathways to independence: Towards producing and using trustworthy evidence. BMJ (Clinical Research Edition). ISSN 0959-8138. 367. doi: 10.1136/bmj.l6576. Show summary

  We all want to base our healthcare decisions on trustworthy evidence. Yet the landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice.1 It highlighted that extensive industry influence may be jeopardising “the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine.” 1 At the same time there’s increasing appreciation across nations and within clinical and scientific communities of the problem of too much medicine.2-5 Overtesting, overdiagnosis, and overtreatment divert resources from tackling genuine need, cause harm to health, and threaten health system sustainability.2-5 Necessary tests, treatments, and diagnoses are vital, and manufacturers have rights to make profits. But it’s time to ensure the scientific evaluation of tests and treatments, and dissemination of the resulting evidence, are conducted as independently as possible from industries profiting from their use. Perspectives differ on the financial relationships between industry and health professionals, and debate is ongoing about where to draw the line between valuable collaboration and relationships that don’t serve patients or the public.6-8 Some see transparency as the best strategy, while others regard it as necessary but insufficient. We argue that endemic financial entanglement is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems. Building on the evidence and practical examples cited below, we propose pathways towards financial independence from industry across healthcare decision making. We hope that our proposals will catalyse and inform development of more detailed recommendations for fundamental reform within research, education, and practice.

• Sun, Xin; Li, Ling; Li, Sheyu; Hao, Qiukui; Wu, Hongmei & Deng, Ke [Show all 14 contributors for this article] (2019). Promoting the rapid creation and effective use of high-quality clinical practice guidelines: MAGIC system and China initiative. Zhongguo Xunzheng Yixue Zazhi. ISSN 1672-2531. 19(1), p. 2–6. doi: 10.7507/1672-2531.201909110.
• Buskermolen, Maaike; Cenin, Dayna R; Helsingen, Lise M.; Guyatt, Gordon; Vandvik, Per Olav & Haug, Ulrike [Show all 8 contributors for this article] (2019). Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. The BMJ. ISSN 1756-1833. 367, p. 1–11. doi: 10.1136/bmj.l5383.
• Jodal, Henriette C.; Helsingen, Lise M.; Anderson, Joseph C.; Lytvyn, Lyubov; Vandvik, Per Olav & Emilsson, Louise (2019). Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis. BMJ Open. ISSN 2044-6055. 9(10), p. 1–18. doi: 10.1136/bmjopen-2019-032773.
• Helsingen, Lise M.; Vandvik, Per Olav; Jodal, Henriette C.; Agoritsas, Thomas; Lytvyn, Lyubov & Anderson, Joseph C. [Show all 21 contributors for this article] (2019). Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: A clinical practice guideline. The BMJ. ISSN 1756-1833. 367:I5515, p. 1–16. doi: 10.1136/bmj.l5515. Show summary

  Abstract CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy. RECOMMENDATIONS: These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids. HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations. THE EVIDENCE: Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk. UNDERSTANDING THE RECOMMENDATION: Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.

• Bekkering, Geertruida E.; Agoritsas, Thomas; Lytvyn, Lyubov; Heen, Anja Fog; Feller, Martin & Moutzouri, Elisavet [Show all 21 contributors for this article] (2019). Thyroid hormones treatment for subclinical hypothyroidism: A clinical practice guideline. The BMJ. ISSN 1756-1833. 365. doi: 10.1136/bmj.l2006. Show summary

  ABSTRACT Clinical question What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current practice Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. Recommendation The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). How this guideline was created A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The evidence The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years’ follow-up. Understanding the recommendation The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.

• Jenum, Anne Karen; Brekke, Idunn; Mdala, Ibrahimu; Muilwijk, Mirthe; Ramachandran, Ambady & Kjøllesdal, Marte Karoline Råberg [Show all 19 contributors for this article] (2019). Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials. Diabetologia. ISSN 0012-186X. 62(8), p. 1337–1348. doi: 10.1007/s00125-019-4905-2.
• Dreesens, Dunja; Stiggelbout, Anne; Agoritsas, Thomas; Elwyn, Glyn; Flottorp, Signe Agnes & Grimshaw, Jeremy [Show all 17 contributors for this article] (2019). A conceptual framework for patient-directed knowledge tools to support patient-centred care: Results from an evidence-informed consensus meeting. Patient Education and Counseling. ISSN 0738-3991. 102(10), p. 1898–1904. doi: 10.1016/j.pec.2019.05.003.
• Du, Heyue; Li, Xiaodan; Su, Na; Li, Ling; Hao, Xiaoting & Gao, Haihui [Show all 18 contributors for this article] (2019). Proprotein convertase subtilisin/kexin 9 inhibitors in reducing cardiovascular outcomes: A systematic review and meta-analysis. Heart. ISSN 1355-6037. 105(15), p. 1149–1159. doi: 10.1136/heartjnl-2019-314763.
• Hao, Quikui; Devji, Tahira; Zeraatkar, Dena; Wang, Yuting; Qasim, Anila & Siemieniuk, Reed A.C. [Show all 11 contributors for this article] (2019). Minimal important differences for improvement in shoulder condition patient-reported outcomes: A systematic review to inform a BMJ Rapid Recommendation. BMJ Open. ISSN 2044-6055. 9:e028777(2), p. 1–10. doi: 10.1136/bmjopen-2018-028777.
• Agoritsas, Thomas; Farhoumand, Pauline Darbellay; Siemieniuk, Reed; Heen, Anja Fog; Lytvyn, Lyubov & MacDonald, Helen [Show all 9 contributors for this article] (2019). The BMJ rapid recommendations: Towards a new model for the production of clinical practice guidelines. Revue Medicale Suisse. ISSN 1660-9379. 15(634), p. 149–155.
• Lähdeoja, Tuomas; Karjalainen, Teemu; Jokihaara, Jarkko; Salamh, Paul; Kavaja, Lauri & Agarwal, Arnav [Show all 11 contributors for this article] (2019). Subacromial decompression surgery for adults with shoulder pain: A systematic review with meta-analysis. British Journal of Sports Medicine. ISSN 0306-3674. p. 1–10. doi: 10.1136/bjsports-2018-100486.
• Vandvik, Per Olav; Lähdeoja, Tuomas; Ardern, Clare; Buchbinder, Rachelle; Moro, Jaydeep & Brox, Jens Ivar [Show all 20 contributors for this article] (2019). Subacromial decompression surgery for adults with shoulder pain: A clinical practice guideline. The BMJ. ISSN 1756-1833. 364:I294, p. 1–8. doi: 10.1136/bmj.l294.
• Karjalainen, Teemu V.; Jain, Nitin B.; Page, Cristina M.; Lähdeoja, Tuomas A.; Johnston, Renea V. & Salamh, Paul [Show all 11 contributors for this article] (2019). Subacromial decompression surgery for rotator cuff disease. Cochrane Database of Systematic Reviews. ISSN 1469-493X. 2019:CD005619(1), p. 1–87. doi: 10.1002/14651858.CD005619.pub3.
• Siemieniuk, Reed A.C.; Chu, Derek K.; Kim, Lisa Ha-Yeon; Güell-Rous, Maria-Rosa; Alhazzani, Waleed & Soccal, Paola M. [Show all 19 contributors for this article] (2019). Oxygen therapy for acutely ill medical patients: A clinical practice guideline. The BMJ. ISSN 1756-1833. 363:k4169, p. 1–10. doi: 10.1136/bmj.k4169.
• Tikkinen, Kari A.O.; Dahm, Philipp; Lytvyn, Lyubov; Heen, Anja Fog; Vernooij, Robin W.M. & Siemieniuk, Reed A.C. [Show all 19 contributors for this article] (2019). Prostate cancer screening with prostate-specific antigen (PSA) test: A clinical practice guideline. The BMJ. ISSN 1756-1833. 362:k3581. doi: 10.1136/bmj.k3581.
• Lamontagne, François; Rochwerg, Bram; Lytvyn, Lyubov; Guyatt, Gordon H.; Møller, Morten Hylander & Annane, Djillali [Show all 24 contributors for this article] (2019). Corticosteroid therapy for sepsis: A clinical practice guideline. The BMJ. ISSN 1756-1833. 362:k3284 , p. 1–8. doi: 10.1136/bmj.k3284.
• Rochwerg, Bram; Almenawer, Saleh A.; Siemieniuk, Reed Alexander C.; Vandvik, Per Olav; Agoritsas, Thomas & Lytvyn, Lyubov [Show all 22 contributors for this article] (2019). Atraumatic (pencil-point) versus conventional needles for lumbar puncture: A clinical practice guideline. The BMJ. ISSN 1756-1833. 361. doi: 10.1136/bmj.k1920.
• Johnston, Bradley C.; Alonso-Coello, Pablo; Bala, Malgorzata M.; Zeraatkar, Dena; Rabassa, Montserrat & Valli, Claudia [Show all 11 contributors for this article] (2018). Methods for trustworthy nutritional recommendations NutriRECS (Nutritional Recommendations and accessible Evidence summaries Composed of Systematic reviews): A protocol. BMC Medical Research Methodology. ISSN 1471-2288. 18:162, p. 1–11. doi: 10.1186/s12874-018-0621-8.
• Prasad, Kameshwar; Siemieniuk, Reed Alexander C.; Hao, Quikui; Guyatt, Gordon H.; O'Donnell, Martin & Lytvyn, Lyubov [Show all 20 contributors for this article] (2018). Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline. BMJ - General Practice Edition. ISSN 0959-8154. 363(k5130). doi: 10.1136/bmj.k5130.
• Agoritsas, Thomas; Merglen, Arnaud; Heen, Anja Fog; Kristiansen, Annette; Neumann, Ignacio & Brito, Juan Pablo [Show all 11 contributors for this article] (2018). UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey. BMJ Open. ISSN 2044-6055. 7(11). doi: 10.1136/bmjopen-2017-018593.
• Busse, Jason W; Wang, Li; Kamaleldin, Mostafa; Craigie, Samantha; Riva, John J. & Montoya, Luis [Show all 36 contributors for this article] (2018). Opioids for chronic noncancer pain: A systematic review and meta-analysis. JAMA Network Open. ISSN 2574-3805. 320(23), p. 2448–2460. doi: 10.1001/jama.2018.18472.
• Fei, Yutong; Guyatt, Gordon Henry; Alexander, Paul Elias; El Dib, Regina; Siemieniuk, Reed A.C. & Vandvik, Per Olav [Show all 13 contributors for this article] (2018). Addition of Ezetimibe to statins for patients at high cardiovascular risk: Systematic review of patient-important outcomes. Journal of Evaluation In Clinical Practice. ISSN 1356-1294. 24(1), p. 222–231. doi: 10.1111/jep.12663.
• Alonso-Coello, Pablo; Oxman, Andrew David; Moberg, Jenny; Brignardello-Petersen, Romina; Akl, Elie A. & Davoli, Marina [Show all 12 contributors for this article] (2018). Marcos GRADE de la evidencia a la decision (EtD): un enfoque sistematico y transparente para tomar decisiones sanitarias bien informadas. 2: Guias de practica clinica. GACETA SANITARIA JOURNAL. ISSN 0213-9111. 32(2), p. 167.e1–167.e10. doi: 10.1016/j.gaceta.2017.03.008. Full text in Research Archive
• Mir, Hassan; Siemieniuk, Reed Alexander C.; Ge, Long Cruz; Foroutan, Farid; Fralick, Michael & Syed, Talha [Show all 12 contributors for this article] (2018). Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence. BMJ Open. ISSN 2044-6055. 8(7). doi: 10.1136/bmjopen-2018-023761. Full text in Research Archive
• van de Velde, Stijn Rita Patrick; Heselmans, Annemie; Delvaux, Nicolas; Brandt, Linn; Ruiz, Luis Marco & Spitaels, David [Show all 13 contributors for this article] (2018). A systematic review of trials evaluating success factors of interventions with computerised clinical decision support. Implementation Science. ISSN 1748-5908. 13. doi: 10.1186/s13012-018-0790-1. Full text in Research Archive
• Neumann, Ignacio; Alonso-Coello, Pablo; Vandvik, Per Olav; Agoritsas, Thomas; Mas, Gemma & Akl, Elie A. [Show all 27 contributors for this article] (2018). Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations. Journal of Clinical Epidemiology. ISSN 0895-4356. 99, p. 33–40. doi: 10.1016/j.jclinepi.2018.02.026.
• van de Velde, Stijn Rita Patrick; Kunnamo, Ilkka; Roshanov, Pavel; Kortteisto, Tiina; Aertgeerts, Bert & Vandvik, Per Olav [Show all 7 contributors for this article] (2018). The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support. Implementation Science. ISSN 1748-5908. 13. doi: 10.1186/s13012-018-0772-3. Full text in Research Archive
• van de Velde, Stijn Rita Patrick; Kortteisto, Tiina; Spitaels, David; Jamtvedt, Gro; Roshanov, Pavel & Kunnamo, Ilkka [Show all 9 contributors for this article] (2018). Development of a tailored intervention with computerized clinical decision support to improve quality of care for patients with knee osteoarthritis: Multi-method study. JMIR Research Protocols. ISSN 1929-0748. 7(6). doi: 10.2196/resprot.9927. Full text in Research Archive
• Vermandere, Mieke; Aertgeerts, Bert; Agoritsas, Thomas; Liu, Catherine; Burgers, Jako & Merglen, Arnaud [Show all 21 contributors for this article] (2018). Antibiotics after incision and drainage for uncomplicated skin abscesses: A clinical practice guideline. BMJ (Clinical Research Edition). ISSN 0959-8138. 360. doi: 10.1136/bmj.k243. Full text in Research Archive
• Kahale, Lara A.; Diab, Batoul; Brignardello-Petersen, Romina; Agarwal, Arnav; Mustafa, Reem A. & Kwong, Joey [Show all 16 contributors for this article] (2018). Systematic reviews do not adequately report or address missing outcome data in their analyses: a methodological survey. Journal of Clinical Epidemiology. ISSN 0895-4356. 99, p. 14–23. doi: 10.1016/j.jclinepi.2018.02.016.

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• Besnier, Elodie Anne Suzanne; Lewin, Simon Arnold; Kredo, Tamara; Oliver, Joy; Leong, Trudy & Durão, Solange [Show all 44 contributors for this article] (2023). Enhancing evidence-informed guideline recommendations for newborn and child health in sub-Saharan Africa.
• Hunskaar, Birk Bårdson Stokke; Løvsletten, Per Olav; Agoritsas, Thomas; Heen, Anja Fog; Achille, Frankie Alexander Spencer & Vandvik, Per Olav (2023). User-testing of a decision support tool for multiple treatment options with NMA data to facilitate guideline development: A qualitative study. Show summary

  Background: While network meta-analysis (NMA) presents unprecedented opportunities for comparative effectiveness research, data output from NMAs is often overwhelming, even for researchers. Little is known on how to best present NMA data to guideline panelists. Objectives: To employ and user test the MATCH-IT tool – an interactive Summary of Findings table (iSoF) presenting data from NMA for multiple interventions – in guideline panels to further answer their information needs and facilitate guideline development. Methods: We performed user testing sessions with semi-structured interviews of panel members in preparation for or after panel meetings in 4 different guideline panels. We also observed the use of the MATCH-IT tool during panel meetings. Interviews and meetings were transcribed, coded and analyzed using directed content analysis to capture the user experience and use of the tool. The analysis informed iterative developments of the tool. Results: User-testing of 15 panel members (3 chairs, 9 clinical experts, 3 patient partners) and 3 observed panel meetings resulted in 4 iterations of the tool including both new features and refinements from the initial prototype. Key improvements included adding color coding as well as new data elements such as 95 % confidence intervals. In the final two rounds of development, chairs and participating panelists expressed that the tool contributed significantly to facilitating the meeting. Conclusions: This study suggests that iSoFs, in this case the MATCH-IT tool, can facilitate guideline development by making data from NMA in systematic reviews easier to understand and navigate.

• Løvsletten, Per Olav; Wang, Xiaoqin; Pitre, Tyler; Ødegaard, Marte; Veroniki, Areti Angeliki & Lunny, Carole [Show all 9 contributors for this article] (2023). Reporting of network meta-analysis results in systematic reviews: a cross- sectional sample of evidence summary presentation formats. Show summary

  Background: Systematic reviews (SRs) with network meta-analysis (NMA) are essential in informing treatment decisions in health policy and practice. However, it is challenging to communicate evidence summaries visually in comprehensible presentation formats. Objective: To map and describe current reporting practices of NMA evidence summaries in SRs, with a specific focus on presentation formats´ reporting of estimates of effect, certainty of the evidence and ranking/categorization. Methods: We searched in MEDLINE for SRs with NMA published 01.01.2020 – 31.12.2021. Presentation formats were labelled and categorized according to whether they reported: 1) effect estimates, 2) certainty of the evidence and/or 3) ranking/categorization of interventions. Results: 200 SRs with 1133 presentation formats from 158 different journals were included. Internal medicine (46 SRs, 23.0%) were the most frequent topic and Forest plots (429, 37.9%) and league tables (188, 16.6%) were the most frequent presentation formats. 76 SRs (38.0%) reported both benefits and harms in presentation formats, 26 SRs (13.0%) reported GRADE or CINeMA certainty ratings and 144 SRs (72.0%) reported ranking/categorization. Focusing on evidence summaries reporting absolute effects across benefits and harms, with GRADE or CINeMA certainty ratings and ranking/categorization of interventions, 3 SRs (1.5%) reported this in presentation formats. Of these, 2 SRs (1.0%) reported such evidence summaries for multiple outcomes within the same (single) presentation format. Discussion: This study demonstrates current challenges and shortcomings in reporting of evidence summaries in presentation formats. Only a small fraction of SRs reported absolute effects across benefits and harms, with certainty ratings and ranking/categorization in tables/figures.

• Løvsletten, Per Olav; Hunskaar, Birk Bårdson Stokke; Bekkering, Geertruida; Vanden Poel, Louise; Zeraatkar, Dena & Busse, Jason W. [Show all 10 contributors for this article] (2023). Evaluation and development of a novel interactive Summary of Findings table for network meta-analysis. A qualitative user-testing study with clinicians. Show summary

  Background: Clinicians often need to evaluate comparative effectiveness of relevant treatment options for their patients. Network meta-analyses (NMAs) provide an important resource for clinicians to guide decision-making; however, these analyses are complex, and interpretation may prove challenging for users. Objectives: To evaluate and develop a novel interactive Summary of Findings table (the MATCH-IT tool) for network meta-analysis results, to support clinicians in interpreting and applying comparative effectiveness evidence into decision-making. Methods: We performed qualitative user-testing with a convenience sample of practicing physicians working in hospitals and general practice in Norway, Belgium, and Canada. User testing entailed a brief introduction with a clinical scenario, which was a think aloud session with participant-tool-interaction followed by a semi-structured interview. The tests were recorded, transcribed, and analysed using directed content analysis. The results informed the iterative development process of the MATCH-IT tool. Results: Five rounds of user-testing, with 26 participants in total, have resulted in four iterations with updates in the tutorial, layout, navigation functionality, and interphase, as well as the practical-issues-section. We have also added an FAQ section. Clinicians who participated in user-testing had been in clinical practice from 0 to 30 years (median 6, IQR 3-11). Most had little or no prior experience with interpretation of NMA results and sparse knowledge about GRADE methodology. Most clinicians perceived MATCH-IT as easy to interpret and navigate and appreciated its ability to provide overview of the evidence, although some of the interactive features proved to be difficult to discover intuitively. They perceived pictograms and inclusion of practical-issues-information as potentially useful features when interacting with patients. Categorization of results with colour coding to indicate both certainty of evidence and relative effectiveness of interventions was appreciated, and filtering functionality allowed participants to efficiently browse and focus in on the interventions believed to be most relevant for a given clinical scenario. Conclusions: MATCH-IT shows promise in supporting decision-making for clinicians when presented with results from NMAs. The tool has already been published within Cochrane systematic reviews and clinical practice guidelines. Patient, public, and/or healthcare consumer involvement: Clinicians were the subject for user testing, ensuring user friendliness for this key consumer group. Network meta-analysis

• Gantzel, Rasmus; Wieszczy, Paulina; Refsum, Erle; Jess, Tine; Larsen, Lone & Bretthauer, Michael [Show all 11 contributors for this article] (2023). Prognostic models for colorectal cancer incidence and mortality in patients with inflammatory bowel disease. Cochrane Database of Systematic Reviews. ISSN 1469-493X. doi: 10.1002/14651858.CD015434.
• Løvsletten, Per Olav; Hunskaar, Birk Bårdson Stokke; Zeraatkar, Dena; Bekkering, Geertruida; Busse, Jason W. & Agoritsas, Thomas [Show all 8 contributors for this article] (2022). Making Alternative Treatment CHoices Intuitive and Trustworthy (MATCH-IT) for Clinicians: Development of a new decision support tool for multiple comparisons from network meta-analyses. Preliminary results from qualitative user-testing. Show summary

  Background The massive increase in published network meta-analyses (NMAs) over the last decade provide new opportunities to empower clinicians and their patients to evaluate comparative effectiveness of relevant treatment options. The amount and complexity of evidence from NMAs present challenges for condensing results into interpretable formats for clinicians. Objective To evaluate and improve a new interactive presentation format for multiple comparisons (the MATCH- IT tool), to support clinicians in interpreting and applying NMA evidence in decision-making. Methods We performed qualitative user-testing with a convenience sample of clinicians working in hospitals and general practice in Norway, Belgium and Canada. User-testing entailed; brief introduction, a think aloud session with participant-tool-interaction followed by a semi-structured interview. The tests were recorded, transcribed and analysed applying directed content analysis. The results informed the iterative development process of the MATCH-IT tool. Results We have completed 21 user-tests. Most participants had little or no prior experience with interpretation of NMA results. The tool is perceived by most as easy interpretable and its ability to provide overview of the evidence were positively appraised. Pictograms and inclusion of practical-issues-information were perceived as potentially useful features when interacting with patients. The testing has led to updates in tutorial, practical-issues-section and interactive features of the tool. Key challenges remain, such as how to best cope with > 10 interventions and ranking of interventions. Discussion The MATCH-IT tool shows promise in supporting decision-making for clinicians when presented with results from NMAs. Future studies will explore its role in shared decision-making and guideline development.

• Song, Yang; Alonso-Coello, Pablo; Ballesteros, Monica; Cluzeau, Francoise; Vernooij, Robin & Arayssi, Thurayya [Show all 36 contributors for this article] (2022). A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist. Annals of Internal Medicine. ISSN 0003-4819. 175(5), p. 710–719. doi: 10.7326/M21-4352.
• Schnell, Oliver; Battelino, Tadej; Bergenstal, Richard; Blüher, Matthias; Böhm, Michael & Brosius, Frank [Show all 29 contributors for this article] (2022). Report from the CVOT Summit 2021: new cardiovascular, renal, and glycemic outcomes. Cardiovascular Diabetology. ISSN 1475-2840. 21(1). doi: 10.1186/s12933-022-01481-0.
• Vandvik, Per Olav; Askie, Lisa; Glen, Fiona; Tendal, Britta & Agoritsas, Thomas (2021). COVID-19: living guidelines help fix cracks in evidence pipeline. Nature. ISSN 0028-0836. 595(7866), p. 172–172. doi: 10.1038/d41586-021-01821-2.
• Vandvik, Per Olav; Elliott, Julian; Lawrence, R; Minx, JC; Oladapo, Olufemi T. & Ravaud, P [Show all 10 contributors for this article] (2021). Decision makers need constantly updated evidence synthesis. Nature. ISSN 0028-0836.
• Bretthauer, Michael; Helsingen, Lise Mørkved; Kalager, Mette; Vandvik, Per Olav; Agoritsas, Thomas & Guyatt, Gordon (2020). The future of colorectal cancer screening: Parentalism or shared decision-making? CMAJ - Canadian Medical Association Journal. ISSN 0820-3946. 192(18). doi: 10.1503/cmaj.74839.
• Munn, Zachary; Twaddle, Sara; Service, Duncan; Harrow, Elaine; Okwen, Patrick Mbah & Schünemann, Holger J. [Show all 7 contributors for this article] (2020). Developing guidelines before, during, and after the COVID-19 pandemic. Annals of Internal Medicine. ISSN 0003-4819. 173(12), p. 1012–1014. doi: 10.7326/M20-4907.
• Johnston, Bradley C.; Alonso-Coello, Pablo; Bala, Malgorzata M.; Zeraatkar, Dena; Rabassa, Montserrat & Valli, Claudia [Show all 11 contributors for this article] (2019). Correction to: Methods for trustworthy nutritional recommendations NutriRECS (Nutritional Recommendations and accessible Evidence summaries Composed of Systematic reviews): A protocol (BMC Medical Research Methodology (2018) 18 (162) DOI: 10.1186/s12874-018-0621-8). BMC Medical Research Methodology. ISSN 1471-2288. 19(1). doi: 10.1186/s12874-019-0888-4.
• Helsingen, Lise M.; Vandvik, Per Olav; Jodal, Henriette C.; Murphy, Silje Bjerkelund; Heen, Anja Fog & Kalager, Mette [Show all 7 contributors for this article] (2019). Tarmkreftscreening, eller ikke? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 139(15). doi: 10.4045/tidsskr.19.0323.
• Heen, Anja Fog; Vandvik, Per Olav & Agoritsas, Thomas (2018). Including practical issues and patient perspectives in Rapid Recommendations. BMJ. British Medical Journal. ISSN 0959-8146. 363. doi: 10.1136/bmj.k4871.
• Jenum, Anne Karen; Brekke, Idunn; Mdala, Ibrahimu; Muilwijk, Mirthe; Ramachandran, Ambady & Kjøllesdal, Marte Karoline Råberg [Show all 15 contributors for this article] (2018). Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: individual participant data meta-analysis of randomsed controlled trials .
• Vandvik, Per Olav; Alhazzani, Waleed & Møller, Morten Hylander (2018). Understanding conflicts of interest. Intensive Care Medicine. ISSN 0342-4642. 44(10), p. 1738–1740. doi: 10.1007/s00134-018-5338-y.
• Kuijpers, Ton; Spencer, Frederick A.; Siemieniuk, Reed A.C.; Vandvik, Per Olav; Otto, Catherine M. & Lytvyn, Lyubov [Show all 20 contributors for this article] (2018). Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke? A clinical practice guideline. The BMJ. ISSN 1756-1833. 362. doi: 10.1136/bmj.k2515.
• Vandvik, Per Olav (2018). Do we have trustworthy guidelines for clinical practice in Norway? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 138(4). doi: 10.4045/tidsskr.18.0102.
• Hagen, Gunhild; Huitfeldt, Anders & Vandvik, Per Olav (2019). Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke. Folkehelseinstituttet. ISSN 978-82-8082-993-1. Full text in Research Archive

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