Per Olav Vandvik

• Nagraj, Sumanth Kumbargere; Hafver, Tandekile Lubelwana; Reinthaler, Valerie; Velde, Stijn Van de; Zaror, Carlos & Shen, Yan Jiao [Vis alle 16 forfattere av denne artikkelen] (2026). Understanding what works in disseminating clinical practice guidelines: A qualitative evidence synthesis. Journal of Clinical Epidemiology. ISSN 0895-4356. 196. doi: 10.1016/j.jclinepi.2026.112313. Fulltekst i vitenarkiv
• Eachempati, Prashanti; Guyatt, Gordon; Vandvik, Per Olav; Guerin, Philippe J.; Dahal, Prabin & Barnes, Karen I. [Vis alle 7 forfattere av denne artikkelen] (2026). SPICE-GRADE: simultaneous processing of indirect causal evidence in complex pathways using GRADE — an exploratory case study. Journal of Clinical Epidemiology. ISSN 0895-4356. 194. doi: 10.1016/j.jclinepi.2026.112219. Fulltekst i vitenarkiv
• Foroutan, Farid; Weiss, Jessica; Mayer, Martin; Bache-Mathiesen, Lena Kristin; Agoritsas, Thomas & Vandvik, Per Olav [Vis alle 11 forfattere av denne artikkelen] (2026). Discriminating clinical prediction models: how outcome incidence and decision thresholds shape clinical utility and apt AUROC values. Journal of Clinical Epidemiology. ISSN 0895-4356. 195. doi: 10.1016/j.jclinepi.2026.112293. Fulltekst i vitenarkiv
• Vandvik, Per Olav; Agarwal, Arnav; Rylance, Jamie; Agoritsas, Thomas; Guyatt, Gordon & Leo, Yee Sin [Vis alle 8 forfattere av denne artikkelen] (2026). Summary of WHO clinical practice guidelines for influenza. The BMJ. 392, s. e087397–e087397. doi: 10.1136/bmj-2025-087397. Fulltekst i vitenarkiv
• Zeng, Linan; Li, Ranyi; Li, Shelly Anne; Clarissa, Sherinne; Agoritsas, Thomas & Chen, Jingjing [Vis alle 12 forfattere av denne artikkelen] (2026). Development of an educational video to support guideline panels in incorporating patient values and preferences into recommendation-making: qualitative one-on-one interviews and brainstorming meetings. BMJ Open. 16(2). doi: 10.1136/bmjopen-2025-101468. Fulltekst i vitenarkiv
• Guyatt, Gordon; Iorio, Alfonso; Beer, Hans De; Owen, Andrew; Agoritsas, Thomas & Murad, M. Hassan [Vis alle 26 forfattere av denne artikkelen] (2025). Core GRADE 5: rating certainty of evidence—assessing indirectness. The BMJ. 389. doi: 10.1136/bmj-2024-083865. Fulltekst i vitenarkiv
• Rayner, Daniel G.; Shah, Darsh; Dai, Si Cheng; Gou, David; Chen, Jason Z.X. & Agarwal, Arnav [Vis alle 11 forfattere av denne artikkelen] (2025). Prognostic models for cardiovascular and kidney outcomes in people with type 2 diabetes: living systematic review and meta-analysis of observational studies. BMJ Medicine. 4(1). doi: 10.1136/bmjmed-2025-001369. Fulltekst i vitenarkiv
• Guyatt, Gordon; Agoritsas, Thomas; Brignardello-Petersen, Romina; Mustafa, Reem A.; Rylance, Jamie & Foroutan, Farid [Vis alle 24 forfattere av denne artikkelen] (2025). Core GRADE 1: Overview of the Core GRADE approach. The BMJ. 389. doi: 10.1136/bmj-2024-081903. Fulltekst i vitenarkiv
• Guyatt, Gordon; Vandvik, Per Olav; Iorio, Alfonso; Agarwal, Arnav; Yao, Liang & Eachempati, Prashanti [Vis alle 17 forfattere av denne artikkelen] (2025). Core GRADE 7: Principles for moving from evidence to recommendations and decisions. The BMJ. 389. doi: 10.1136/bmj-2024-083867. Fulltekst i vitenarkiv
• Nong, Kailei; Jeppesen, Britta Tendal; Shi, Qingyang; Agoritsas, Thomas; Guyatt, Gordon H. & White, Heath [Vis alle 36 forfattere av denne artikkelen] (2025). Medications for adults with type 2 diabetes: A living systematic review and network meta-analysis. The BMJ. doi: 10.1136/bmj-2024-083039. Fulltekst i vitenarkiv
• Halvorsen, Natalie Grace Mosteiro; Hassan, Cesare; Correale, Loredana; Pilonis, Nastazja Dagny; Helsingen, Lise Mørkved & Spadaccini, Marco [Vis alle 14 forfattere av denne artikkelen] (2025). Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study. BMJ Medicine. 4(1). doi: 10.1136/bmjmed-2025-001446. Fulltekst i vitenarkiv
• Ibrahim, Sara; Siemieniuk, Reed A.C.; Oliveros, Maria Jose; Islam, Nazmul; Martinez, Juan Pablo Diaz & Izcovich, Ariel [Vis alle 42 forfattere av denne artikkelen] (2025). Drug treatments for mild or moderate covid-19: Systematic review and network meta-analysis. The BMJ. 389. doi: 10.1136/bmj-2024-081165. Fulltekst i vitenarkiv
• Chowdhury, Saifur R.; Islam, Nazmul; Zhou, Qi; Hasan, Md Kamrul; Chowdhury, Mahmudur Rahman & Siemieniuk, Reed AC [Vis alle 12 forfattere av denne artikkelen] (2025). Metformin for covid-19: systematic review and meta-analysis of randomised controlled trials. BMJ Medicine. 4(1). doi: 10.1136/bmjmed-2024-001126. Fulltekst i vitenarkiv
• Guyatt, Gordon; Wang, Ying; Eachempati, Prashanti; Iorio, Alfonso; Murad, M. Hassan & Hultcrantz, Monica [Vis alle 14 forfattere av denne artikkelen] (2025). Core GRADE 4: Rating certainty of evidence - Risk of bias, publication bias, and reasons for rating up certainty. The BMJ. doi: 10.1136/bmj-2024-083864. Fulltekst i vitenarkiv
• Guyatt, Gordon; Zeng, Linan; Brignardello-Petersen, Romina; Prasad, Manya; Beer, Hans De & Murad, M. Hassan [Vis alle 18 forfattere av denne artikkelen] (2025). Core GRADE 2: Choosing the target of certainty rating and assessing imprecision. The BMJ. 389. doi: 10.1136/bmj-2024-081904. Fulltekst i vitenarkiv
• Zaror, Carlos; Klenner, Maura; Song, Yang; Agoritsas, Thomas; Balaciano, Giselle & Sanguine, Verónica [Vis alle 14 forfattere av denne artikkelen] (2025). Adapting World Health Organization COVID-19 living guidelines balancing methodological rigor with efficiency and flexibility: a case study from Argentina. Journal of Clinical Epidemiology. ISSN 0895-4356. 184. doi: 10.1016/j.jclinepi.2025.111823. Fulltekst i vitenarkiv
• Guyatt, Gordon; Yao, Liang; Murad, M. Hassan; Hultcrantz, Monica; Agoritsas, Thomas & Beer, Hans De [Vis alle 20 forfattere av denne artikkelen] (2025). Core GRADE 6: Presenting the evidence in summary of findings tables. The BMJ. 389. doi: 10.1136/bmj-2024-083866. Fulltekst i vitenarkiv
• Yang, Mengting; Luo, Yuan; He, Tong; Diao, Sha; Li, Hailong & Zou, Kun [Vis alle 15 forfattere av denne artikkelen] (2025). Application of artificial intelligence to measure and predict patient values and preferences: a scoping review. npj Digital Medicine. 8, s. 1–12. doi: 10.1038/s41746-025-02156-2. Fulltekst i vitenarkiv Vis sammendrag

  Patients’ voices are often difficult to capture directly in healthcare decisions. This scoping review examines how artificial intelligence (AI) has been applied to measure and predict patient values and preferences, aiming to evaluate its potential to generate reliable, patient-centered evidence, identify opportunities and challenges, and explore AI tools in literature reviews. Analyzing 67 studies, we summarize how AI processes diverse data sources such as social media, clinical records, and patient surveys to extract population- and individual-based patient values and preferences. Researchers have applied AI for efficient data preprocessing, extraction, analysis, integration, and modeling. Despite promising validation results (e.g., >80% accuracy in data preprocessing), key challenges remain, such as data quality issues, lack of real-world validation, and ethical concerns. This review underscores the potential of AI in patient values and preferences research and calls for greater transparency and real-world implementation to better align healthcare delivery with patient needs.

• Seterelv, Siri Schøyen; Gupta, Samir; Kouri, Andrew; Florez, Ivan D; Agoritsas, Thomas & Vandvik, Per Olav [Vis alle 7 forfattere av denne artikkelen] (2025). From international guidelines to practice: a multimethod evaluation of BMJ Rapid Recommendations focusing on suitability for adaptation and implementation. BMJ Open. 15(12), s. e114609–e114609. doi: 10.1136/bmjopen-2025-114609. Fulltekst i vitenarkiv Vis sammendrag

  Objectives We aimed to assess usage and explore factors influencing the suitability of British Medical Journal (BMJ) Rapid Recommendations—a set of international guidelines meeting standards of trustworthiness—for adaptation and implementation, further defined as implementability. Design Qualitative descriptive study with a multimethod approach. Participants We used citation screening and a survey to identify groups that had used any of a sample of 14 BMJ Rapid Recommendations in adoption, adaptation, de novo guideline development or implementation. Setting 12 participants from a range of country income levels were interviewed, using semistructured interviews. Methods Interviews were analysed using thematic analysis to identify themes related to implementability of the guidelines. We compared these findings with those from a critical appraisal conducted using three different appraisal tools. Results BMJ Rapid Recommendations are used in high-income, middle-income and low-income countries. We identified 33 instances of use. Our thematic analysis of the interviews uncovered 14 challenges to implementability, categorised under perceived trustworthiness, comprehensibility and practical relevance. The critical appraisals gave the BMJ Rapid Recommendations high scores on validity, but low scores on implementability and measurability. The challenges found in the interviews were generally corroborated by the appraisals, but the comparison also exposed tensions such as the complex interaction between methodological rigour and perceived credibility, the balance between novelty and compatibility with current practice, and the difficulty of offering globally applicable yet locally practical guidance. Conclusion Implementability challenges may limit effective use of international guidelines globally. Recognising and reflecting on tensions between rigour, credibility and contextual feasibility may help improve their uptake and value. The next phase of this research will explore strategies to enhance guideline implementability during their development.

• Guyatt, Gordon; Schandelmaier, Stefan; Brignardello-Petersen, Romina; Beer, Hans De; Prasad, Manya & Murad, M. Hassan [Vis alle 18 forfattere av denne artikkelen] (2025). Core GRADE 3: Rating certainty of evidence - Assessing inconsistency. The BMJ. 2025. doi: 10.1136/bmj-2024-081905. Fulltekst i vitenarkiv
• Hirschel, Tiffany; Vandvik, Per Olav & Agoritsas, Thomas (2025). Clinicians' experience with infographic summaries from the BMJ Rapid Recommendations: a qualitative user-testing study among residents and interns at a large teaching hospital in Switzerland. BMJ Open. 15(2). doi: 10.1136/bmjopen-2023-083032. Fulltekst i vitenarkiv
• Foroutan, Farid; Vandvik, Per Olav; Helsingen, Lise Mørkved; Kalager, Mette; Rutter, Matt & Selby, Kevin [Vis alle 26 forfattere av denne artikkelen] (2025). Computer aided detection and diagnosis of polyps in adult patients undergoing colonoscopy: a living clinical practice guideline. The BMJ. doi: 10.1136/bmj-2024-082656. Fulltekst i vitenarkiv
• Barnard-Kelly, Katharine; Battelino, Tadej; Brosius, Frank C.; Ceriello, Antonio; Cosentino, Francesco & Gavin, James R. [Vis alle 26 forfattere av denne artikkelen] (2025). Defining patient-reported outcomes in diabetes, obesity, cardiovascular disease, and chronic kidney disease for clinical practice guidelines - perspectives of the taskforce of the Guideline Workshop. Cardiovascular Diabetology. 24(1), s. 68–68. doi: 10.1186/s12933-024-02550-2. Fulltekst i vitenarkiv Vis sammendrag

  Recent clinical practice guidelines for diabetes, obesity, cardiovascular disease (CVD) and chronic kidney disease (CKD) emphasise a holistic, person-centred approach to care. However, they do not include recommendations for the assessment of patient-reported outcomes (PROs), which would – dependent on the topic of guideline – be important for improving shared decision-making, patients’ concordance with guideline recommendations, clinical outcomes and health-related quality of life (HRQoL). The Taskforce of the Guideline Workshop discussed PROs in diabetes, obesity, CVD and CKD as well as the relevance of their inclusion in clinical practice guidelines for the management of these conditions.

• Busse, Jason W; Genevay, Stéphane; Agarwal, Arnav; Standaert, Christopher J; Carneiro, Kevin & Friedrich, Jason [Vis alle 26 forfattere av denne artikkelen] (2025). Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. The BMJ. 388. doi: 10.1136/bmj-2024-079970. Fulltekst i vitenarkiv Vis sammendrag

  Clinical question: What is the comparative effectiveness and safety of commonly used interventional procedures (such as spinal injections and ablation procedures) for chronic axial and radicular spine pain that is not associated with cancer or inflammatory arthropathy? Current practice: Chronic spine pain is a common, potentially disabling complaint, for which clinicians often administer interventional procedures. However, clinical practice guidelines provide inconsistent recommendations for their use. Recommendations: For people living with chronic axial spine pain (≥3 months), the guideline panel issued strong recommendations against: joint radiofrequency ablation with or without joint targeted injection of local anaesthetic plus steroid; epidural injection of local anaesthetic, steroids, or their combination; joint-targeted injection of local anaesthetic, steroids, or their combination; and intramuscular injection of local anaesthetic with or without steroids. For people living with chronic radicular spine pain (≥3 months), the guideline panel issued strong recommendations against: dorsal root ganglion radiofrequency with or without epidural injection of local anaesthetic or local anaesthetic plus steroids; and epidural injection of local anaesthetic, steroids, or their combination. How this guideline was created: An international guideline development panel including four people living with chronic spine pain, 10 clinicians with experience managing chronic spine pain, and eight methodologists, produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation provided methodological support. The guideline panel applied an individual patient perspective when formulating recommendations. The evidence: These recommendations are informed by a linked systematic review and network meta-analysis of randomised trials and a systematic review of observational studies, summarising the current body of evidence for benefits and harms of common interventional procedures for axial and radicular, chronic, non-cancer spine pain. Specifically, injection of local anaesthetic, steroids, or their combination into the cervical or lumbar facet joint or sacroiliac joint; epidural injections of local anaesthetic, steroids, or their combination; radiofrequency of dorsal root ganglion; radiofrequency denervation of cervical or lumbar facet joints or the sacroiliac joint; and paravertebral intramuscular injections of local anaesthetic, steroids, or their combination. Understanding the recommendations: These recommendations apply to people living with chronic spine pain (≥3 months duration) that is not associated with cancer or inflammatory arthropathy and do not apply to the management of acute spine pain. Further research is warranted and may alter recommendations in the future: in particular, whether there are differences in treatment effects based on subtypes of chronic spine pain, establishing the effectiveness of interventional procedures currently supported by low or very low certainty evidence, and effects on poorly reported patient-important outcomes (such as opioid use, return to work, and sleep quality).

• Guyatt, Gordon; Hultcrantz, Monica; Agoritsas, Thomas; Iorio, Alfonso; Vandvik, Per Olav & Montori, Victor M. (2025). Why Core GRADE is needed: Introduction to a new series in the BMJ. The BMJ. doi: 10.1136/bmj-2024-081902. Fulltekst i vitenarkiv
• Hassan, Cesare; Rizkala, Tommy; Mori, Yuichi; Spadaccini, Marco; Misawa, Masashi & Antonelli, Giulio [Vis alle 31 forfattere av denne artikkelen] (2024). Computer-Aided Diagnosis for the Resect and Discard Strategy for Colorectal Polyps: A Systematic Review and Meta-Analysis. The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. 9(11), s. 1010–1019. doi: 10.1016/S2468-1253(24)00222-X. Fulltekst i vitenarkiv Vis sammendrag

  Background: The Resect and Discard strategy allows endoscopists to replace post-polypectomy pathology with real-time prediction of polyp histology during colonoscopy (optical diagnosis). The present systematic review and meta-analysis investigated how the implementation of computer-aided diagnosis (CADx) for polyp pathology affected the Resect and Discard strategy. Methods: We conducted a search of MEDLINE, EMBASE, and Scopus databases, covering studies published from inception to June 5, 2024. No language restrictions were applied. We included diagnostic accuracy studies that evaluated the real-time optical diagnosis performance of CADx systems, as compared to histology, for polyps ≤5mm in the entire colon. The aim was to estimate the potential benefits and harms associated with integrating CADx assistance into the endoscopist optical diagnosis, both before and after its implementation. The primary outcome were the proportion of polyps that would have avoided pathological assessment (main benefit) and the proportion of polyps incorrectly predicted (main harm) due to false-positive or -negative optical diagnosis. When the endoscopists were involved in the optical diagnosis, our analysis included only their predictions made with high confidence. We used a random effect model to calculate all outcomes. Findings: Our literature search identified a total of 377 studies, 11 of which met eligibility criteria. A total of 11 studies with 7,400 polyps were eligible for analysis. Three studies (1,817 patients; A total of 11 studies with 7,400 polyps were eligible for analysis. Three studies (1,817 patients; 4,086 polyps) provided data to directly compare the primary benefit/harm outcome measures between the CADx-unassisted and CADx-assisted strategies. There was no significant difference between the CADx-unassisted and CADx-assisted strategies for the proportion of polyps that would have avoided pathological assessment (3,588/4,086, 90% vs. 3,653/4,086 90%; risk ratio: 1.01; 95% CI: 0.99, 1.04; I^2 108 =53.49%; low certainty evidence; 3 studies; Egger test p=0.18). CADx-assisted strategy reduced the proportion of incorrectly predicted polyps as compared with CADx-unassisted strategy (582/3,588, 13% vs. 523/3,653, 12%; risk ratio: 0.88; 95% CI: 0.79, 0.98; I^2=0%; low certainty evidence; 3 studies; Egger test p=0.18) mainly due to a decrease in false positive diagnosis. Interpretation: CADx-assistance failed to improve the main outcomes of Resect-and-Discard strategy in clinical studies, questioning its value in clinical practice. Funding: European Commission (Horizon Europe 101057099). The Japan Society of Promotion of Science (No. 22H03357). Associazione Italiana per la Ricerca sul Cancro (AIRC): IG 2022 – ID. 27843 project – P.I. Hassan Cesare. Registration: PROSPERO CRD42024508440

• Hassan, Cesare; Misawa, Masashi; Rizkala, Tommy; Mori, Yuichi; Sultan, Shahnaz & Facciorusso, Antonio [Vis alle 26 forfattere av denne artikkelen] (2024). Computer-Aided Diagnosis for Leaving-In-Situ of Colorectal Polyps: A Systematic Review and Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. 177(7), s. 919–929. doi: 10.7326/M23-2865. Fulltekst i vitenarkiv Vis sammendrag

  Backround: Computer-aided diagnosis (CADx) allows prediction of polyp histology during colonoscopy, which may reduce unnecessary removal of nonneoplastic polyps. However, the benefits and potential harms of CADx are still unclear. Purpose: To quantify the benefit and harm of using CADx in colonoscopy for the optical diagnosis of small (≤5-mm) rectosigmoid polyps. Data Sources: Medline, Embase, and Scopus were searched for articles published before 22 December 2023. Study Selection: Histologically verified diagnostic accuracy studies that evaluated the real-time performance of physicians in predicting neoplastic change of small rectosigmoid polyps without or with CADx assistance during colonoscopy. Data Extraction: The clinical benefit and harm were estimated on the basis of accuracy values of the endoscopist before and after CADx assistance. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The outcome measure for benefit was the proportion of polyps predicted to be nonneoplastic that would avoid removal with the use of CADx. The outcome measure for harm was the proportion of neoplastic polyps that would be not resected and left in situ due to an incorrect diagnosis with the use of CADx. Histology served as the reference standard for both outcomes. Data Synthesis: Ten studies, including 3620 patients with 4103 small rectosigmoid polyps, were analyzed. The studies that assessed the standalone performance of CADx (9 studies; 3237 polyps) showed a sensitivity of 87.3% (95% CI, 79.2% to 92.5%) (SR) and specificity of 88.9% (CI, 81.7% to 93.5%) (SR) in predicting neoplastic change. In the studies that compared histology prediction performance before versus after CADx assistance (4 studies; 2503 polyps), there was no difference in the proportion of polyps predicted to be nonneoplastic that would avoid removal (55.4% vs. 58.4%; risk ratio [RR], 1.06 [CI, 0.96 to 1.17]; moderate-certainty evidence) or in the proportion of neoplastic polyps that would be erroneously left in situ (8.2% vs. 7.5%; RR, 0.95 [CI, 0.69 to 1.33]; moderate-certainty evidence). Limitation: The application of optical diagnosis was only simulated, potentially altering the decision-making process of the operator. Conclusion: Computer-aided diagnosis provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy. Primary Funding Source: European Commission. (PROSPERO: CRD42023402197)

• Zou, Xinyu; Shi, Qingyang; Vandvik, Per Olav; Mao, Yunhe; Agarwal, Arnav & Ponte, Belen [Vis alle 12 forfattere av denne artikkelen] (2024). Sodium-glucose co-transporter-2 inhibitors in patients with chronic kidney disease with or without type 2 diabetes: systematic review and meta-analysis. BMJ Medicine. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objective To examine cardiovascular and kidney benefits and harms of sodium-glucose co-transporter-2 (SGLT-2) inhibitors stratified by risk in adults with chronic kidney disease regardless of diabetes status. Design Systematic review and meta-analysis. Data sources Ovid Medline, Embase, and Cochrane Central from database inception to 15 June 2024. Eligibility criteria for selecting studies Randomised controlled trials that compared SGLT-2 inhibitors with placebo or standard care with no SGLT-2 inhibitors in adults with chronic kidney disease with a follow-up duration of ≥12 weeks were eligible. Secondary analyses based on subpopulations from randomised controlled trials and publications not in English language were excluded. Data synthesis Random effects meta-analyses were conducted, with effect estimates presented as risk ratios with 95% confidence intervals (CIs). Absolute treatment effects were estimated over a five year duration for individuals with varied risks of cardiovascular and kidney complications based on the Kidney Disease Improving Global Outcomes (KDIGO) risk stratification system. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results Evidence from 13 randomised controlled trials (29 614 patients) informed treatment effect estimates. In relative terms, SGLT-2 inhibitors reduced all cause death (risk ratio 0.85 (95% CI 0.74 to 0.98)), cardiovascular death (0.84 (0.74 to 0.96)), kidney failure (0.68 (0.60 to 0.77)), non-fatal stroke (0.73 (0.57 to 0.94)), non-fatal myocardial infarction (0.75 (0.60 to 0.93)), and admission to hospital for heart failure (0.68 (0.60 to 0.78)). No credible subgroup effects were found from diabetes status, heart failure status, estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, and follow-up duration. Absolute effect estimates across these outcomes over a five year period varied across risk groups based on baseline risks of cardiovascular and kidney events. Effects of SGLT-2 inhibitors in the group at low risk included seven fewer all- cause deaths, four fewer admissions to hospital for heart failure per 1000 individuals, and no effects on kidney failure. Effects in the higher risk group included 48 fewer all cause deaths, 58 fewer kidney failures, and 25 fewer admissions to hospital for heart failure per 1000 individuals. Although SGLT-2 inhibitor use was associated with a relative increase in the risk of harms, including genital infection (2.66 (95% CI 2.07 to 3.42)), ketoacidosis (2.27 (1.30 to 3.95)), and symptomatic hypovolaemia (1.29 (1.15 to 1.44)), absolute differences for all harm outcomes were small. Conclusions Among people who have chronic kidney disease either with type 2 diabetes or not, SGLT-2 inhibitors improved cardiovascular and kidney outcomes with varying degrees of absolute benefit depending on an individual's baseline risks of cardiovascular and kidney-related sequelae. Absolute benefits and harms stratified by risk and associated with SGLT-2 inhibitors should inform individual decision making at the patient level.

• Zeraatkar, Dena; Kawano-Dourado, Leticia; Kristianslund, Eirik Klami & Vandvik, Per Olav (2024). Proactive therapeutic drug monitoring of biologic drugs in patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis: systematic review and meta-analysis. BMJ Medicine. doi: 10.1136/bmjmed-2024-000998. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objective To address the efficacy and safety of proactive therapeutic drug monitoring of biologic drugs for patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis. Design Systematic review and meta-analysis. Data sources Medline, Embase, Central, and CINAHL, from database inception to 23 May 2024. Eligibility criteria for selecting studies Trials including people with inflammatory bowel disease, inflammatory arthritis, and psoriasis were selected. Selected trials also randomly assigned people to either proactive therapeutic drug monitoring of tumour necrosis factor-alpha inhibitors or other biologic drugs in the intervention group, and to either no therapeutic drug monitoring or standard care in the control group. Reviewers worked independently and in duplicate to screen search records and collect data from eligible trials. For each outcome, a frequentist, pairwise, random effects meta-analysis was done and the certainty of evidence was assessed using GRADE (grading of recommendations, assessment, development, and evaluations). Results Of 10 eligible trials identified, reporting on 2383 patients, two investigated induction with infliximab (533 patients), four assessed maintenance with infliximab (901 patients), and three assessed maintenance with adalimumab (710 patients). One trial was of maintenance with infliximab, adalimumab, and etanercept (239 patients). For patients who had induction with infliximab, the effects of proactive therapeutic drug monitoring on remission and adverse events were uncertain. Low certainty evidence suggested that proactive therapeutic drug monitoring may have little or no effect on disease activity, physical function, mental health, and quality of life. For patients who had maintenance with infliximab, low certainty evidence suggested that proactive therapeutic drug monitoring may increase the proportion of patients who had sustained disease control or remission (relative risk 1.26 (95% confidence interval (CI) 1.14 to 1.40), absolute risk difference of 146 more per 1000 patients treated for one year (95% CI 78 to 224). Additionally, this treatment and monitoring may reduce disease worsening, and may have little or no effect on disease activity, physical function, mental health, and quality of life. The effects of proactive therapeutic drug monitoring of infliximab on adverse events and formation of anti-drug antibodies were uncertain. For patients who had maintenance with adalimumab, the effects of proactive therapeutic drug monitoring were uncertain. Conclusion Proactive therapeutic drug monitoring of infliximab during maintenance may help patients to have sustained disease control or remission. No compelling evidence supported the effectiveness of proactive therapeutic drug monitoring of infliximab during induction or proactive therapeutic drug monitoring of adalimumab during maintenance.

• Hassan, Cesare; Misawa, Masashi; Rizkala, Tommy; Mori, Yuichi; Sultan, Shahnaz & Facciorusso, Antonio [Vis alle 25 forfattere av denne artikkelen] (2024). Computer-Aided Diagnosis for Leaving Colorectal Polyps In Situ A Systematic Review and Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. 177(7), s. 919–928. doi: 10.7326/M23-2865. Fulltekst i vitenarkiv
• Hunskaar, Birk Bårdson Stokke; Løvsletten, Per Olav; Achille, Frankie Alexander Spencer; Heen, Anja Fog; Agoritsas, Thomas & Vandvik, Per Olav (2024). MATCH-IT: A decision support tool for multiple comparisons presenting data from network meta-analysis to facilitate guideline development. Clinical and Public Health Guidelines. 1(4). doi: 10.1002/gin2.70003. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Network meta‐analysis (NMA) provides unprecedentedopportunities to compare multiple treatment options (multiple comparisons)and are increasingly being used to inform clinical practice guidelines.However, the overwhelming amount of data generated from NMAs ischallenging to present in comprehensible overviews for end‐users, guidelinepanelists included. Acknowledging these challenges, we developedMATCH‐IT—an interactive evidence summary displaying NMA results formultiple comparisons. In this study, we conducted user‐testing and furtherdeveloped MATCH‐IT to support guideline panels in moving from NMAevidence to recommendations.Methods: We user‐tested the tool with guideline panelists and observed theuse of the tool in panel meetings. User‐testing sessions and guidelinemeetings were recorded, transcribed, and analyzed. The analysis informedthe iterative development in the tool.Results: We included four guideline panels and tested the tool with 15panelists (four chairs, four methodologists, five clinic

• Mthethwa, Mashudu; Mbeye, Nyanyiwe Masingi; Effa, Emmanuel; Arikpo, Dachi; Blose, Ntombifuthi & Brand, Amanda [Vis alle 21 forfattere av denne artikkelen] (2024). Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10682-0. Fulltekst i vitenarkiv Vis sammendrag

  Low and middle-income countries remain disproportionately affected by high rates of child mortality. Clinical practice guidelines are essential clinical tools supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based guidelines play a key role in improving clinical management to impact child mortality. We aimed to identify and assess the quality of guidelines for newborn and child health published in South Africa, Nigeria and Malawi in the last 5 years (2017–2022). We identified 40-guidelines from the three countries. Of these, 8/40 reported being adopted from a parent guideline. More guidelines (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). Guidelines were most often developed by national health ministries (n = 30) and professional societies (n = 14). Eighteen guidelines reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used in 1/7 guidelines that reported assessing certainty of evidence. Overall guidelines scored well on two AGREE II domains: scope and purpose median (IQR) score 68% (IQR 47–83), and clarity of presentation 81% (67–94). Domains critical for ensuring credible guidance scored below 20%: rigour of development 11% (4–32) and editorial independence 6% (0–27).

• Hassan, Cesare; Rizkala, Tommy; Mori, Yuichi; Spadaccini, Marco; Misawa, Masashi & Antonelli, Giulio [Vis alle 33 forfattere av denne artikkelen] (2024). Computer-aided diagnosis for the resect-and-discard strategy for colorectal polyps: a systematic review and meta-analysis. The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. 9(11), s. 1010–1019. doi: 10.1016/S2468-1253(24)00222-X. Fulltekst i vitenarkiv
• Løvsletten, Per Olav; Wang, Xiaoqin; Pitre, Tyler; Ødegaard, Marte; Veroniki, Areti Angeliki & Lunny, Carole [Vis alle 9 forfattere av denne artikkelen] (2024). A systematic survey of 200 systematic reviews with network meta-analysis (published 2020–2021) reveals that few reviews report structured evidence summaries. Journal of Clinical Epidemiology. ISSN 0895-4356. 173. doi: 10.1016/j.jclinepi.2024.111445. Fulltekst i vitenarkiv Vis sammendrag

  Objectives - To map whether and how systematic reviews (SRs) with network meta-analysis (NMA) use presentation formats to report (a) structured evidence summaries – here defined as reporting of effects estimates in absolute effects with certainty ratings and with a method to rate interventions across one or more outcome(s) – and (b) NMA results in general.<p> <p>Study Design and Setting - We conducted a systematic survey, searching MEDLINE (Ovid) for SRs with NMA published between January 1, 2020, and December 31, 2021. We planned to include a random sample of publications, with predefined mechanisms in place for saturation, and included SRs that met prespecified quality criteria and extracted data on presentation formats that reported: (a) estimates of effects, (b) certainty of the evidence, or (c) rating of interventions.<p> <p>Results - The 200 eligible SRs, from 158 unique Journals, utilized 1133 presentation formats. We found structured evidence summaries in 10 publications (5.0%), with 3 (1.5%) reporting structured evidence summaries across all outcomes, including benefits and harms. Sixteen of the 133 SRs (11.7%) reporting dichotomous outcomes included estimates of absolute effects. Seventy-six SRs (38.0%) reported both benefits and harms and 26 SRs (13.0%) reported certainty ratings in presentation formats, 20 (76.9%) used Grading of Recommendations Assessment, Development and Evaluation and 6 (23.1%) used Confidence In Network Meta-analysis. Surface Under the Cumulative Ranking Curve was the most common method to rate interventions (69 SRs, 34.5%). NMA results were most often reported using forest plots (108 SRs, 54.0%) and league tables (93 SRs, 46.5%).<p> <p>Conclusion - Most SRs with NMA do not report structured evidence summaries and only rarely do such summaries include reporting of both benefits and harms; those that do offer effective user-friendly communication and provide models for optimal NMA presentation practice.

• Kredo, Tamara; Effa, Emmanuel; Mbeye, Nyanyiwe; Mabetha, Denny; Schmidt, Bey-Marrié & Rohwer, Anke [Vis alle 14 forfattere av denne artikkelen] (2024). Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol. Health Research Policy and Systems. 22(1). doi: 10.1186/s12961-024-01189-5. Fulltekst i vitenarkiv Vis sammendrag

  Background: Poverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG development process is complex and resource-intensive, with substantial scope for improving the process in SSA, which is the goal of the Global Evidence, Local Adaptation (GELA) project. The impact of research on PRD will be maximized through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant CPGs in the field of newborn and child health. The project will be implemented in three SSA countries, Malawi, South Africa and Nigeria, over a 3-year period. This research protocol is for the monitoring and evaluation work package of the project. The aim of this work package is to monitor the various GELA project activities and evaluate the influence these may have on evidence-informed decision-making and guideline adaptation capacities and processes. The specific project activities we will monitor include (1) our ongoing engagement with local stakeholders, (2) their capacity needs and development, (3) their understanding and use of evidence from reviews of qualitative research and, (4) their overall views and experiences of the project. Methods: We will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change. A series of interconnected qualitative and quantitative data collections methods will be used, including knowledge translation tracking sheets and case studies, capacity assessment online surveys, user testing and in-depth interviews, and non-participant observations of project activities. Participants will comprise of project staff, members of the CPG panels and steering committees in Malawi, South Africa and Nigeria, as well as other local stakeholders in these three African countries. Discussion: Ongoing monitoring and evaluation will help ensure the relationship between researchers and stakeholders is supported from the project start. This can facilitate achievement of common goals and enable researchers in South Africa, Malawi and Nigeria to make adjustments to project activities to maximize stakeholder engagement and research utilization. Ethical approval has been provided by South African Medical Research Council Human Research Ethics Committee (EC015-7/2022); The College of Medicine Research and Ethics Committee, Malawi (P.07/22/3687); National Health Research Ethics Committee of Nigeria (01/01/2007).

• Kawano-Dourado, Leticia; Kristianslund, Eirik; Zeraatkar, Dena; Jani, Meghna; Makharia, Govind & Hazlewood, Glen [Vis alle 23 forfattere av denne artikkelen] (2024). Proactive therapeutic drug monitoring of biologic drugs in adult patients with inflammatory bowel disease, inflammatory arthritis, or psoriasis: a clinical practice guideline. The BMJ. 387. doi: 10.1136/bmj-2024-079830. Fulltekst i vitenarkiv
• Indregard, Anne Marthe Rustad; Nussle, Hans Martin; Hagen, Milada; Vandvik, Per Olav; Tesli, Martin Steen & Gather, Jakov [Vis alle 7 forfattere av denne artikkelen] (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. 11(5), s. 330–338. doi: 10.1016/S2215-0366(24)00039-7. Fulltekst i vitenarkiv Vis sammendrag

  Background - Open-door policy is a recommended framework to reduce coercion in psychiatric wards. However, existing observational data might not fully capture potential increases in harm and use of coercion associated with open-door policies. In this first randomised controlled trial, we compared coercive practices in open-door policy and treatment-as-usual wards in an urban hospital setting. We hypothesised that the open-door policy would be non-inferior to treatment-as-usual on the proportion of patients exposed to coercive measures.<p> <p>Methods - We conducted a pragmatic, randomised controlled, non-inferiority trial comparing two open-door policy wards and three treatment-as-usual acute psychiatric wards at Lovisenberg Diaconal Hospital in Oslo, Norway. An exemption from the consent requirements enabled inclusion and random allocation of all patients admitted to these wards using an open list (2:3 ratio) administrated by a team of ward nurses. The primary outcome was the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation or seclusion, and physical and mechanical restraints. The non-inferiority margin was set to 15%. Primary and safety analyses were assessed using the intention-to-treat population. The trial is registered with ISRCTN registry and is complete, ISRCTN16876467.<p> <p>Findings - Between Feb 10, 2021, and Feb 1, 2022, we randomly assigned 556 patients to either open-door policy wards (n=245; mean age 41·6 [SD 14·5] years; 119 [49%] male; 126 [51%] female; and 180 [73%] admitted to the ward involuntarily) or treatment-as-usual wards (n=311; mean age 41·6 [4·3] years; 172 [55%] male and 138 [45%] female; 233 [75%] admitted involuntarily). Data on race and ethnicity were not collected. The open-door policy was non-inferior to treatment-as-usual on all outcomes: the proportion of patient stays with exposure to coercion was 65 (26·5%) in open-door policy wards and 104 (33·4%) in treatment-as-usual wards (risk difference 6·9%; 95% CI –0·7 to 14·5), with a similar trend for specific measures of coercion. Reported incidents of violence against staff were 0·15 per patient stay in open-door policy wards and 0·18 in treatment-as-usual wards. There were no suicides during the randomised controlled trial period.<p> <p>Interpretation - The open-door policy could be safely implemented without increased use of coercive measures. Our findings underscore the need for more reliable and relevant randomised trials to investigate how a complex intervention, such as open-door policy, can be efficiently implemented across health-care systems and contexts.

• Agarwal, Arnav; Zeng, Xiaoxi; Li, Sheyu; Rayner, Daniel; Foroutan, Farid & Aertgeerts, Bert [Vis alle 18 forfattere av denne artikkelen] (2024). Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline. BMJ (Clinical Research Edition). ISSN 0959-8138. 387. doi: 10.1136/bmj-2024-080257. Fulltekst i vitenarkiv
• Durão, Solange; Effa, Emmanuel; Mbeye, Nyanyiwe; Mthethwa, Mashudu; McCaul, Michael & Naude, Celeste [Vis alle 17 forfattere av denne artikkelen] (2024). Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria. Health Research Policy and Systems. 22(1). doi: 10.1186/s12961-024-01133-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach. Methods We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed. Results Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants. Conclusions Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.

• Løvsletten, Per Olav; Hunskaar, Birk Bårdson Stokke; Heen, Anja Fog; Bekkering, Geertruida; Poel, Louise Vanden & Zeraatkar, Dena [Vis alle 13 forfattere av denne artikkelen] (2024). Physicians found an interactive tool displaying structured evidence summaries for multiple comparisons understandable and useful: a qualitative user testing study. Journal of Clinical Epidemiology. ISSN 0895-4356. 172. doi: 10.1016/j.jclinepi.2024.111399. Fulltekst i vitenarkiv
• Wang, Yang; Zhang, Shipeng; Du, Heyue; Li, Jing; Khan, Safi U. & Aertgeerts, Bert [Vis alle 16 forfattere av denne artikkelen] (2023). Safety of ezetimibe in lipid-lowering treatment: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ Medicine. 1(1). doi: 10.1136/bmjmed-2022-000134. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives To investigate medical students’ ability to interpret evidence, as well as their self-assessed understandability, perceived usefulness and preferences for design alternatives in an interactive decision support tool, displaying GRADE evidence summaries for multiple treatment options (Making Alternative Treatment CHoices Intuitive and Trustworthy, MATCH-IT). Design A combined randomised controlled trial and survey. Participants were presented with a clinical scenario and randomised to one of two versions of the MATCH-IT tool (A/B), instructed to explore the evidence and decide on a recommendation. Participants answered a questionnaire assessing interpretation, treatment recommendation self-assessed understandability and perceived usefulness before exposure to the other MATCH-IT version and asked questions on design preferences. Setting Online lecture in an evidence-based medicine (EBM) introductory course. Participants 149 third-year medical students. 52% (n=77) had 6 months of clinical training and 48% (n=72) had preclinical training only. Interventions The MATCH-IT tool version A uses colour coding to categorise interventions by magnitude and direction of effects and displays all outcomes in a table on entry. Version B has no colour coding, and the user must decide which outcomes to display in the table. Main outcome measures Interpretation of evidence, treatment recommendation, perceived usefulness and understandability, preference for format and design alternatives. Results 82.5% (n=123) of medical students correctly answered ≥4 out of 5 multiple choice questions assessing interpretation of data. 75.8% (n=114) of students made a treatment recommendation in accordance with an expert panel for the same clinical scenario. 87.2% (n=130) found the tool understandable while 91.9% perceived the tool as useful in addressing the clinical scenario. Conclusion Medical students with no prior training in EBM can interpret and use the MATCH-IT tool. Certain design alternatives were preferred but had no bearing on interpretation of evidence or understandability of the tool.

• Busse, Jason W.; Casassus, Rodrigo; Carrasco-Labra, Alonso; Durham, Justin; Mock, David & Zakrzewska, Joanna M. [Vis alle 20 forfattere av denne artikkelen] (2023). Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. The BMJ. 383. doi: 10.1136/bmj-2023-076227. Fulltekst i vitenarkiv
• Zeng, Linan; Helsingen, Lise Mørkved; Bretthauer, Michael; Agoritsas, Thomas; Vandvik, Per Olav & Mustafa, Reem A. [Vis alle 15 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• Alme, Tomas Nordheim; Andreasson, Anna; Asprusten, Tarjei Tørre; Bakken, Anne Karen; Beadsworth, Michael BJ & Boye, Birgitte [Vis alle 51 forfattere av denne artikkelen] (2023). Chronic fatigue syndromes: real illnesses that people can recover from. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), s. 372–376. doi: 10.1080/02813432.2023.2235609. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Zeng, Linan; Li, Shelly-Anne; Yang, Mengting; Yan, Lijiao; Helsingen, Lise Mørkved & Bretthauer, Michael [Vis alle 15 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• Shi, Qingyang; Nong, Kailei; Vandvik, Per Olav; Guyatt, Gordon H.; Schnell, Oliver & Rydén, Lars [Vis alle 40 forfattere av denne artikkelen] (2023). Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. The BMJ. 381, s. e074068–e074068. doi: 10.1136/bmj-2022-074068. Fulltekst i vitenarkiv
• Hassan, Cesare; Spadaccini, Marco; Mori, Yuichi; Foroutan, Farid; Facciorusso, Antonio & Gkolfakis, Paraskevas [Vis alle 23 forfattere av denne artikkelen] (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), s. 1209–1220. doi: 10.7326/M22-3678. Fulltekst i vitenarkiv
• Owen, Andrew; Diaz, Janet Victoria; Gyatt, Gordon; Lamontagne, Francis; Stegemann, Miriam & Vandvik, Per Olav [Vis alle 7 forfattere av denne artikkelen] (2022). WHO Living Guidelines on antivirals for COVID-19 are evidence-based. The Lancet. ISSN 0140-6736. 400(10369), s. 2196–2198. doi: 10.1016/S0140-6736(22)02306-6. Fulltekst i vitenarkiv
• Li, Jing; Du, Heyue; Wang, Yang; Aertgeerts, Bert; Guyatt, Gordon & Hao, Qiukui [Vis alle 17 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• O'Connor, Denise; Johnston, Renea V; Brignardello-Petersen, Romina; Poolman, Rudolf W; Cyril, Sheila & Vandvik, Per Olav [Vis alle 7 forfattere av denne artikkelen] (2022). Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database of Systematic Reviews. 2022(3), s. 1–158. doi: 10.1002/14651858.CD014328. Fulltekst i vitenarkiv
• McCaul, Michael; Tovey, David; Young, Taryn; Welch, Vivian; Dewidar, Omar & Goetghebeur, Mireille [Vis alle 15 forfattere av denne artikkelen] (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, s. 88–95. doi: 10.1016/j.jclinepi.2022.07.008. Fulltekst i vitenarkiv
• Zou, Xinyu; Shi, Qingyang; Vandvik, Per Olav; Guyatt, Gordon; Lang, Chim C. & Parpia, Sameer [Vis alle 13 forfattere av denne artikkelen] (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), s. 851–861. doi: 10.7326/M21-4284. Fulltekst i vitenarkiv
• Zeraatkar, Dena; Cusano, Ellen; Martinez, Juan PD; Qasim, Anila; Mangala, Sophia & Kum, Elena [Vis alle 17 forfattere av denne artikkelen] (2022). Use of tocilizumab and sarilumab alone or in combination with corticosteroids for covid-19: systematic review and network meta-analysis. BMJ Medicine. 1(1). doi: 10.1136/bmjmed-2021-000036. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To compare the effects of interleukin 6 receptor blockers, tocilizumab and sarilumab, with or without corticosteroids, on mortality in patients with covid-19. Design: Systematic review and network meta-analysis. Data sources: World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature, and two prospective meta-analyses (up to 9 June 2021). Review methods: Trials in which people with suspected, probable, or confirmed covid-19 were randomised to interleukin 6 receptor blockers (with or without corticosteroids), corticosteroids, placebo, or standard care. The analysis used a bayesian framework and assessed the certainty of evidence using the GRADE approach. Results from the fixed effect meta-analysis were used for the primary analysis. Results: Of 45 eligible trials (20 650 patients) identified, 36 (19 350 patients) could be included in the network meta-analysis. Of 36 trials, 27 were at high risk of bias, primarily due to lack of blinding. Tocilizumab, in combination with corticosteroids, suggested a reduction in the risk of death compared with corticosteroids alone (odds ratio 0.79, 95% credible interval 0.70 to 0.88; 35 fewer deaths per 1000 people, 95% credible interval 52 fewer to 18 fewer per 1000; moderate certainty of evidence), as did sarilumab in combination with corticosteroids, compared with corticosteroids alone (0.73, 0.58 to 0.92; 43 fewer per 1000, 73 fewer to 12 fewer; low certainty). Tocilizumab and sarilumab, each in combination with corticosteroids, appeared to have similar effects on mortality when compared with each other (1.07, 0.86 to 1.34; eight more per 1000, 20 fewer to 35 more; low certainty). The effects of tocilizumab (1.12, 0.91 to 1.38; 20 more per 1000, 16 fewer to 59 more; low certainty) and sarilumab (1.07, 0.81 to 1.40; 11 more per 1000, 38 fewer to 55 more; low certainty), when used alone, suggested an increase in the risk of death. Conclusion: These findings suggest that in patients with severe or critical covid-19, tocilizumab, in combination with corticosteroids, probably reduces mortality, and that sarilumab, in combination with corticosteroids, might also reduce mortality. Tocilizumab and sarilumab, in combination with corticosteroids, could have similar effectiveness. Tocilizumab and sarilumab, when used alone, might not be beneficial.

• Khan, Safi U; Yedlapati, Siva H; Lone, Ahmad N; Hao, Qiukui; Guyatt, Gordon & Delvaux, Nicolas [Vis alle 12 forfattere av denne artikkelen] (2022). PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: A systematic review and network meta-analysis. The BMJ. 2022(377). doi: 10.1136/bmj-2021-069116. Fulltekst i vitenarkiv
• Hao, Qiukui; Aertgeerts, Bert; Guyatt, Gordon; Bekkering, Geertruida E; Vandvik, Per Olav & Khan, Safi U [Vis alle 27 forfattere av denne artikkelen] (2022). PCSK9 inhibitors and ezetimibe for the reduction of cardiovascular events: A clinical practice guideline with risk-stratified recommendations. The BMJ. 2022(377). doi: 10.1136/bmj-2021-069066. Fulltekst i vitenarkiv
• Carrano, Francesco M.; Iossa, Angelo; Lorenzo, Nicola Di; Silecchia, Gianfranco; Kontouli, Katerina-Maria & Mavridis, Dimitris [Vis alle 38 forfattere av denne artikkelen] (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, s. 1709–1725. doi: 10.1007/s00464-022-09008-0. Fulltekst i vitenarkiv
• Milone, Marco; Adamina, Michel; Arezzo, Alberto; Bejinariu, Nona; Boni, Luigi & Bouvy, Nicole [Vis alle 17 forfattere av denne artikkelen] (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), s. 2221–2232. doi: 10.1007/s00464-022-09090-4. Fulltekst i vitenarkiv
• Izcovich, Ariel; Siemieniuk, Reed Alexander; Bartoszko, Jessica Julia; Ge, Long; Zeraatka, Dena & Kum, Elena [Vis alle 15 forfattere av denne artikkelen] (2022). Adverse effects of remdesivir, hydroxychloroquine and lopinavir/ritonavir when used for COVID-19: systematic review and meta-analysis of randomised trials. BMJ Open. 12(3). doi: 10.1136/bmjopen-2020-048502. Fulltekst i vitenarkiv
• Zeng, Linan; Walsh, Michael; Guyatt, Gordon H; Siemieniuk, Reed A C; Collister, David & Booth, Michelle [Vis alle 22 forfattere av denne artikkelen] (2022). Plasma exchange and glucocorticoid dosing for patients with ANCA-associated vasculitis: A clinical practice guideline. The BMJ. doi: 10.1136/bmj-2021-064597. Fulltekst i vitenarkiv
• Riaz, Irbaz Bin; Fuentes, Harry E.; Naqvi, Syed Arsalan Ahmed; Huan, He; Sipra, Qurat-Ul-Ain Riaz & Tafur, Alfonso J. [Vis alle 16 forfattere av denne artikkelen] (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), s. 308–324. doi: 10.1016/j.mayocp.2020.10.041. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Heen, Anja Fog; Lytvyn, Lyubov; Shapiro, Michael; Guyatt, Gordon; Siemieniuk, Reed Alexander Cunningham & Zhang, Yuan [Vis alle 9 forfattere av denne artikkelen] (2021). Patient values and preferences on valve replacement for aortic stenosis: A systematic review. Heart. ISSN 1355-6037. s. 1–7. doi: 10.1136/heartjnl-2020-318334. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Buchan, Tayler A.; Malik, Abdullah; Chan, Cynthia; Chambers, Jason; Suk, Yujin & Zhu, Jie Wei [Vis alle 15 forfattere av denne artikkelen] (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), s. 1962–1973. doi: 10.1136/heartjnl-2021-319243. Fulltekst i vitenarkiv
• Bartoszko, Jessica; Siemieniuk, Reed A.C.; Kum, Elena; Qasim, Anila; Zeraatkar, Dena & Ge, Long [Vis alle 40 forfattere av denne artikkelen] (2021). Prophylaxis against covid-19: Living systematic review and network meta-analysis. BMJ. British Medical Journal. ISSN 0959-8146. 373, s. 1–19. doi: 10.1136/bmj.n949. Fulltekst i vitenarkiv
• Siemieniuk, Reed A.C.; Bartoszko, Jessica J; Martinez, Juan Pablo Díaz; Kum, Elena; Qasim, Anila & Zeraatkar, Dena [Vis alle 36 forfattere av denne artikkelen] (2021). Antibody and cellular therapies for treatment of covid-19: A living systematic review and network meta-analysis. The BMJ. 374, s. 2231–2231. doi: 10.1136/bmj.n2231. Fulltekst i vitenarkiv
• Honarmand, Kimia; Penn, Jeremy; Agarwal, Arnav; Siemieniuk, Reed A.C.; Brignardello-Petersen, Romina & Bartoszko, Jessica [Vis alle 19 forfattere av denne artikkelen] (2021). Clinical trials in COVID-19 management & prevention: A meta-epidemiological study examining methodological quality. Journal of Clinical Epidemiology. ISSN 0895-4356. 139, s. 68–79. doi: 10.1016/j.jclinepi.2021.07.002. Fulltekst i vitenarkiv
• Heen, Anja Fog; Vandvik, Per Olav; Brandt, Linn; Achille, Frankie; Guyatt, Gordon Henry & Akl, Elie A. [Vis alle 8 forfattere av denne artikkelen] (2021). Decision aids linked to evidence summaries and clinical practice guidelines: results from user-testing in clinical encounters. BMC Medical Informatics and Decision Making. 21, s. 1–15. doi: 10.1186/s12911-021-01541-7. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Palmer, Suetonia C.; Tendal, Britta; Mustafa, Reem A.; Vandvik, Per Olav; Li, Sheyu & Hao, Qiukui [Vis alle 44 forfattere av denne artikkelen] (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, s. 1–14. doi: 10.1136/bmj.m4573. Fulltekst i vitenarkiv
• Li, Sheyu; Vandvik, Per Olav; Lytvyn, Lyubov; Guyatt, Gordon; Palmer, Suetonia C. & Rodriguez-Gutierrez, René [Vis alle 28 forfattere av denne artikkelen] (2021). SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: A clinical practice guideline. The BMJ. 373. doi: 10.1136/bmj.n1091. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Riaz, Irbaz Bin; He, Huan; Ryu, Alexander J.; Siddiqi, Rabbia; Naqvi, Syed Arsalan Ahmed & Yao, Yuan [Vis alle 22 forfattere av denne artikkelen] (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), s. 712–723. doi: 10.1016/j.eururo.2021.03.016. Fulltekst i vitenarkiv
• Busse, Jason W.; Vankrunkelsven, Patrick; Zeng, Linan; Heen, Anja Fog; Merglen, Arnaud & Campbell, Fiona [Vis alle 22 forfattere av denne artikkelen] (2021). Medical cannabis or cannabinoids for chronic pain: A clinical practice guideline. The BMJ. 374. doi: 10.1136/bmj.n2040. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Lamontagne, Francois; Agoritsas, Thomas; Siemieniuk, Reed A.C.; Rochwerg, Bram; Bartoszko, Jessica & Askie, Lisa [Vis alle 53 forfattere av denne artikkelen] (2021). A living WHO guideline on drugs to prevent covid-19. The BMJ. doi: 10.1136/bmj.n526. Fulltekst i vitenarkiv
• Antoniou, Stavros A.; Mavridis, Dimitris; Kontouli, Katerina Maria; Drakopoulos, Vasileios; Gorter-Stam, Marguerite & Eriksson, Sture [Vis alle 13 forfattere av denne artikkelen] (2021). EAES rapid guideline: appendicitis in the elderly. Surgical Endoscopy. ISSN 0930-2794. 35(7), s. 3233–3243. doi: 10.1007/s00464-021-08524-9. Fulltekst i vitenarkiv
• Shi, Q; Wang, Y; Hao, Qiukui; Vandvik, Per Olav; Guyatt, Gordon & Li, J [Vis alle 27 forfattere av denne artikkelen] (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), s. 259–269. doi: 10.1016/S0140-6736(21)01640-8. Fulltekst i vitenarkiv
• Marx, Nikolaus; Ryden, Lars; Brosius, Frank; Ceriello, Antonio; Cheung, Michael & Cosentino, Francesco [Vis alle 17 forfattere av denne artikkelen] (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, s. 108870–108870. doi: 10.1016/j.diabres.2021.108870. Fulltekst i vitenarkiv
• Vandvik, Per Olav; González-González, José Gerardo; González-Colmenero, Alejandro Díaz; Millán-Alanís, Juan Manuel; Lytvyn, Lyubov & Solis, Ricardo Cesar [Vis alle 12 forfattere av denne artikkelen] (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. 11(7), s. e049130–-e049130. doi: 10.1136/bmjopen-2021-049130. Fulltekst i vitenarkiv
• 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, s. 1–6. doi: 10.1136/bmj.m3869. Fulltekst i vitenarkiv
• Siemieniuk, Reed A.C.; Bartoszko, Jessica J; Ge, Long; Zeraatkar, Dena; Izcovich, Ariel & Kum, Elena [Vis alle 53 forfattere av denne artikkelen] (2020). Drug treatments for covid-19: living systematic review and network meta-analysis. The BMJ. 370. doi: 10.1136/bmj.m2980. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objective To compare the effects of treatments for coronavirus disease 2019 (covid-19). Design Living systematic review and network meta-analysis. Data sources WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2020 and six additional Chinese databases up to 12 November 2020. Study selection Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles. Methods After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance. Results 85 trials enrolling 41 669 patients met inclusion criteria as of 21 October 2020; 50 (58.8%) trials and 25 081 (60.2%) patients are new from the previous iteration; 43 (50.6%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, corticosteroids probably reduce death (risk difference 17 fewer per 1000 patients, 95% credible interval 34 fewer to 1 more, moderate certainty), mechanical ventilation (29 fewer per 1000 patients, 54 fewer to 1 more, moderate certainty), and days free from mechanical ventilation (2.6 fewer, 0.2 fewer to 5.0 fewer, moderate certainty). The impact of remdesivir on mortality, mechanical ventilation, length of hospital stay, and duration of symptoms is uncertain, but it probably does not substantially increase adverse effects leading to drug discontinuation (0 more per 1000, 9 fewer to 40 more, moderate certainty). Azithromycin, hydroxychloroquine, lopinavir/ritonavir, interferon-beta, and tocilizumab may not reduce risk of death or have an effect on any other patient-important outcome. The certainty in effects for all other interventions was low or very low. Conclusion Corticosteroids probably reduce mortality and mechanical ventilation in patients with covid-19 compared with standard care, whereas azithromycin, hydroxychloroquine, interferon-beta, and tocilizumab may not reduce either. Whether or not remdesivir confers any patient-important benefit remains uncertain. Systematic review registration This review was not registered. The protocol is included as a supplement. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is the second update of the original article published on 30 July 2020 ( BMJ 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.

• Helsingen, Lise M.; Zeng, Linan; Siemieniuk, Reed A.C.; Lytvyn, Lyubov; Vandvik, Per Olav & Agoritsas, Thomas [Vis alle 8 forfattere av denne artikkelen] (2020). Establishing thresholds for important benefits considering the harms of screening interventions. BMJ Open. 10:e037854(12), s. 1–9. doi: 10.1136/bmjopen-2020-037854. Fulltekst i vitenarkiv
• Marx, Nikolaus; Rydén, Lars E.; Brosius, Frank; Ceriello, Antonio; Cheung, Michael & Cosentino, Francesco [Vis alle 15 forfattere av denne artikkelen] (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), s. 546–552. doi: 10.1089/dia.2020.0086. Fulltekst i vitenarkiv
• Moynihan, Ray; Bero, Lisa; Hill, Sue; Johansson, Minna; Lexchin, Joel & MacDonald, Helen [Vis alle 16 forfattere av denne artikkelen] (2020). Pathways to independence: Towards producing and using trustworthy evidence. BMJ (Clinical Research Edition). ISSN 0959-8138. 367. doi: 10.1136/bmj.l6576. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Foroutan, Farid; Guyatt, Gordon H.; Zuk, Victoria; Vandvik, Per Olav; Alba, Ana C. & Mustafa, Reem A. [Vis alle 17 forfattere av denne artikkelen] (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, s. 62–70. doi: 10.1016/j.jclinepi.2019.12.023. Fulltekst i vitenarkiv
• 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, s. 166–170. doi: 10.1016/j.jclinepi.2020.02.008. Fulltekst i vitenarkiv
• Lamontagne, Francois; Agoritsas, Thomas; MacDonald, Helen; Leo, Yee-Sin; DIaz, Janet & Agarwal, Arnav [Vis alle 40 forfattere av denne artikkelen] (2020). A living WHO guideline on drugs for covid-19. The BMJ. 370. doi: 10.1136/bmj.m3379. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Agarwal, Arnav; Mustafa, Reem; Manja, Veena; Agoritsas, Thomas; MacDonald, Helen & Li, Sheyu [Vis alle 24 forfattere av denne artikkelen] (2025). Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes: A living clinical practice guideline. The BMJ. 390. doi: 10.1136/bmj-2024-082071. Fulltekst i vitenarkiv
• Helsingen, Lise Mørkved; Langeland, Eline Aurvoll; Pisani, Synne Eline Rotihaug; Vandvik, Per Olav; Haavardsholm, Espen A. & Malt, Ulrik Fredrik [Vis alle 10 forfattere av denne artikkelen] (2024). Glansbilder av nasjonale faglige retningslinjer fra Helsedirektoratet. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(5). doi: 10.4045/tidsskr.24.0141. Fulltekst i vitenarkiv
• Kunøe, Nikolaj; Indregard, Anne Marthe Rustad; Nussle, Hans Martin; Tesli, Martin Steen; Vandvik, Per Olav & Gather, Jakov (2024). A pragmatic randomised controlled non-inferiority trial of open-door policy versus treatment as usual in urban psychiatric inpatient wards. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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; Hunskaar, Birk Bårdson Stokke; Bekkering, Geertruida; Poel, Louise Vanden; Zeraatkar, Dena & Busse, Jason W. [Vis alle 10 forfattere av denne artikkelen] (2023). Evaluation and development of a novel interactive Summary of Findings table for network meta-analysis. A qualitative user-testing study with clinicians. Fulltekst i vitenarkiv Vis sammendrag

  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

• Løvsletten, Per Olav; Wang, Xiaoqin; Pitre, Tyler; Ødegaard, Marte; Veroniki, Areti Angeliki & Lunny, Carole [Vis alle 9 forfattere av denne artikkelen] (2023). Reporting of network meta-analysis results in systematic reviews: a cross- sectional sample of evidence summary presentation formats. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Besnier, Elodie Anne Suzanne; Lewin, Simon Arnold; Kredo, Tamara; Oliver, Joy; Leong, Trudy & Durão, Solange [Vis alle 44 forfattere av denne artikkelen] (2023). Enhancing evidence-informed guideline recommendations for newborn and child health in sub-Saharan Africa. Fulltekst i vitenarkiv
• Gantzel, Rasmus; Wieszczy, Paulina; Refsum, Erle; Jess, Tine; Larsen, Lone & Bretthauer, Michael [Vis alle 11 forfattere av denne artikkelen] (2023). Prognostic models for colorectal cancer incidence and mortality in patients with inflammatory bowel disease. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD015434. Fulltekst i vitenarkiv
• Løvsletten, Per Olav; Hunskaar, Birk Bårdson Stokke; Zeraatkar, Dena; Bekkering, Geertruida; Busse, Jason W. & Agoritsas, Thomas [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 36 forfattere av denne artikkelen] (2022). A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist. Annals of Internal Medicine. ISSN 0003-4819. 175(5), s. 710–719. doi: 10.7326/M21-4352. Fulltekst i vitenarkiv
• Schnell, Oliver; Battelino, Tadej; Bergenstal, Richard; Blüher, Matthias; Böhm, Michael & Brosius, Frank [Vis alle 29 forfattere av denne artikkelen] (2022). Report from the CVOT Summit 2021: new cardiovascular, renal, and glycemic outcomes. Cardiovascular Diabetology. 21(1), s. 50–50. doi: 10.1186/s12933-022-01481-0. Fulltekst i vitenarkiv
• Vandvik, Per Olav; Elliott, Julian; Lawrence, R; Minx, JC; Oladapo, Olufemi T. & Ravaud, P [Vis alle 10 forfattere av denne artikkelen] (2021). Decision makers need constantly updated evidence synthesis. Fulltekst i vitenarkiv
• Løvsletten, Per Olav; Veroniki, Areti Angeliki; Lunny, Carole; Vandvik, Per Olav; Agoritsas, Thomas & Tricco, Andrea C. [Vis alle 7 forfattere av denne artikkelen] (2021). Evidence summaries in systematic reviews with network meta-analysis: protocol of a systematic survey of existing approaches and presentation formats. Open Science Framework (OSF). doi: 10.17605/OSF.IO/Y3JER. Fulltekst i vitenarkiv
• 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), s. 172–172. doi: 10.1038/d41586-021-01821-2. Fulltekst i vitenarkiv
• Munn, Zachary; Twaddle, Sara; Service, Duncan; Harrow, Elaine; Okwen, Patrick Mbah & Schünemann, Holger J. [Vis alle 7 forfattere av denne artikkelen] (2020). Developing guidelines before, during, and after the COVID-19 pandemic. Annals of Internal Medicine. ISSN 0003-4819. 173(12), s. 1012–1014. doi: 10.7326/M20-4907. Fulltekst i vitenarkiv
• 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), s. E484–E484. doi: 10.1503/cmaj.74839. Fulltekst i vitenarkiv

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