Publications by authors named "Akl E"

Objective: To describe the processes of reconciling overlapping guidance and prioritizing practice questions for a World Health Organization (WHO) guideline on Infection Prevention and Control (IPC) for Ebola and Marburg disease.

Methods: This work involved the reconciliation of guidance, the generation of potential practice questions and the prioritization of those questions. Contributors included the WHO secretariat, the WHO steering group, the guideline methodologists, and the guideline development group (GDG).

View Article and Find Full Text PDF

Introduction: GRADE and other Evidence to Decision (EtD) frameworks are widely used by guideline development groups (GDG) and other decision-makers. When GDGs judge the magnitude of desirable and undesirable health outcomes on EtDs, they typically categorize them as trivial, small, moderate or large. However, generic judgment or decision thresholds (DTs) that could guide the user about such estimates of effect size or serve as references for interpretation of findings are not yet available.

View Article and Find Full Text PDF

Plaque erosion is the second most common cause of acute coronary syndromes (ACS). Small studies using optical coherence tomography (OCT) have shown favorable outcomes in select patients with plaque erosion treated conservatively without stent implantation. Unlike plaque rupture, the role of plaque erosion in the formation of healed plaques and subsequent flow-limiting coronary stenoses is less certain.

View Article and Find Full Text PDF

Biomechanical analysis of spinal structures is crucial in the evaluation of injuries, the risk of fracture, and age-related changes. Osteoporotic vertebrae are very fragile and therefore constitute a serious risk, especially in the elderly. At present, clinically relevant decision making in fracture risk assessment is predicated upon finite element analysis (FEA), which utilizes high-resolution computed tomography (CT) scans from clinical practice alongside micro-CT scans from laboratory settings.

View Article and Find Full Text PDF

Background: Health guideline developers engage with interested people and groups to ensure that guidelines and their recommendations are relevant and useful to those who will be affected by them. These 'interest-holders' include patients, payers/purchasers of health services, payers of health research, peer review editors, product makers, programme managers, policymakers, providers, principal investigators, and the public. The Guidelines International Network (GIN) and McMaster University Guideline Development Checklist describes 146 steps of the guideline process organized into 18 topics.

View Article and Find Full Text PDF

Care-coordination platforms may optimize ST-elevation myocardial infarction (STEMI) treatment delays. This study aimed to assess the impact of Stenoa use on treatment delays in STEMI patients. We conducted a retrospective cohort study on local STEMI cases for the period between September 2020 and March 2023, comparing the times from first medical contact to device, before vs after the implementation of the Stenoa platform by the catheterization laboratory (cath-lab) and emergency department.

View Article and Find Full Text PDF
Article Synopsis
  • The study focuses on identifying risk factors for stent thrombosis (ST) in patients with STEMI who underwent primary PCI, using data from the TOTAL trial involving over 10,000 patients.
  • Out of the participants, 1.54% experienced ST within a year, with factors like prior heart attacks, number of stents, and certain medications influencing risk.
  • The findings suggest that while ST remains a common complication, different predictors exist for ST occurring at different times after the procedure, emphasizing the need for tailored preventive strategies.
View Article and Find Full Text PDF

COVID-19-related critical and acute illness are associated with an increased risk of venous thromboembolism (VTE). These evidence-based recommendations of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other healthcare professionals in decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19-related critical illness, acute illness, and those being discharged from the hospital, who do not have suspected or confirmed VTE. ASH formed a multidisciplinary panel, including three patient representatives, and applied a conflicts of interest management policy to minimize potential bias.

View Article and Find Full Text PDF

This is the protocol for a Campbell systematic review. The objectives are as follows. The objective of this review is to identify and synthesize empirical research on the impacts of interest-holder engagement on the guideline development process and content.

View Article and Find Full Text PDF
Article Synopsis
  • - Human African trypanosomiasis is a severe neglected tropical disease that can be fatal without treatment, and the WHO has updated its treatment guidelines after a thorough review.
  • - Fexinidazole is now the preferred first-line treatment for patients aged 6 years and over who weigh at least 20 kg, eliminating the need for invasive lumbar punctures for staging the disease.
  • - While fexinidazole improves treatment options and reduces the risk of severe side effects from previous medicines, it remains unavailable for children who don't meet the age or weight criteria, making interim use of pentamidine necessary in some cases.
View Article and Find Full Text PDF
Article Synopsis
  • Vitamin D deficiency is common after bariatric surgery and may negatively affect bone health, but the ideal supplementation dosage is unclear.
  • This study aims to compare the effects of different vitamin D doses on adults with obesity undergoing bariatric surgery, including low, moderate, and high doses versus placebo.
  • Five trials with a total of 314 participants were analyzed, indicating that moderate-dose vitamin D (3200 IU/day) could improve vitamin D status with minimal adverse effects compared to a placebo.
View Article and Find Full Text PDF

Background And Objective: The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT.

Methods: Through iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance.

View Article and Find Full Text PDF

Objective: This scoping review will identify existing literature regarding contextual factors relevant to vector-control interventions to prevent malaria. We will use the findings of the scoping review to produce an interactive evidence and gap map. The map will assist in the priority setting, development, and conduct of targeted systematic reviews.

View Article and Find Full Text PDF

Background: The learning curve for new operators performing ultrasound-guided transfemoral access (TFA) remains uncertain.

Methods: We performed a pooled analysis of the FAUST (Femoral Arterial Access With Ultrasound Trial) and UNIVERSAL (Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures) trials, both multicenter randomized controlled trials of 1:1 ultrasound-guided versus non-ultrasound-guided TFA for coronary procedures. Outcomes included the composite of major bleeding or vascular complications and successful common femoral artery cannulation.

View Article and Find Full Text PDF

Background: A recommendation by the World Health Organization (WHO) was issued about the use of chest imaging to monitor pulmonary sequelae following recovery from COVID-19. This qualitative study aimed to explore the perspective of key stakeholders to understand their valuation of the outcome of the proposition, preferences for the modalities of chest imaging, acceptability, feasibility, impact on equity and practical considerations influencing the implementation of using chest imaging.

Methods: A qualitative descriptive design using in-depth interviews approach.

View Article and Find Full Text PDF

Intravascular imaging has become an integral part of the diagnostic and management strategies for intracoronary pathologies. In this White Paper we summarize current evidence and its implications on the use of intravascular imaging in interventional cardiology practice. The areas addressed are planning and optimization of percutaneous coronary intervention, management of stent failure, and evaluation of ambiguous coronary lesions and myocardial infarction with nonobstructive coronary disease.

View Article and Find Full Text PDF

Background: Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines.

Objective: To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist.

View Article and Find Full Text PDF

Background: In patients with ST elevation myocardial infarction (STEMI), intracoronary thrombolysis (ICT) may reduce thrombotic burden and microvascular obstruction in the infarct-related artery. We performed a meta-analysis to evaluate the role of adjunctive low-dose ICT during primary percutaneous coronary intervention (PPCI) in improving clinical outcomes and indices of microvascular function.

Methods: We searched electronic databases (Cochrane, EMBASE, Medline; inception to October 2023) for randomized controlled trials (RCTs) evaluating the effects of adjunctive ICT in STEMI patients undergoing PPCI, compared with placebo or usual care.

View Article and Find Full Text PDF

Objectives: To provide guidance on rating imprecision in a body of evidence assessing the accuracy of a single test. This guide will clarify when Grading of Recommendations Assessment, Development and Evaluation (GRADE) users should consider rating down the certainty of evidence by one or more levels for imprecision in test accuracy.

Study Design And Setting: A project group within the GRADE working group conducted iterative discussions and presentations at GRADE working group meetings to produce this guidance.

View Article and Find Full Text PDF

The Arab region is experiencing the largest youth cohort in its history. Parental influence is a clear factor in the well-being of this demographic. This scoping review serves as the first consolidated synthesis of existing research on parenting in the Arab world, aimed at identifying research gaps and informing future research agendas.

View Article and Find Full Text PDF
Article Synopsis
  • Observational epidemiologic studies are important for understanding how environmental, occupational, and behavioral factors impact human health, and systematic reviews help guide policies based on these studies.
  • A new assessment tool called Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E) has been created to evaluate the risk of bias in cohort studies examining the effects of specific exposures on outcomes.
  • ROBINS-E offers a structured method to assess bias through multiple domains using signaling questions, and aims to improve how biases are integrated into evidence synthesis and causal inference in research.
View Article and Find Full Text PDF

Background: The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare systems globally, particularly in terms of access to medicines. Lebanon has been greatly affected by the pandemic, having faced concomitant financial and economic crises. The objective of the study was to understand the experiences of patients with COVID-19 in Lebanon, as well as those of their families, and healthcare providers, with regards to their treatment decisions and accessibility to COVID-19 medicines.

View Article and Find Full Text PDF