2021 Evidence Foundation Scholar Receives Health Equity Travel Scholarship

The Evidence Foundation is proud to announce that spring 2021 GRADE Workshop Scholar Ifeoluwa Babatunde, Pharm.D, MS, received the 2025 Encoding Health Equity Summit Travel Scholarship for Patients and Emerging Leaders, an opportunity made possible by Doris Duke Foundation and the Council of Medical Specialty Societies (CMSS). 

About her experience at the summit, Babatunde shared,

"The Encoding Equity conference was an enriching experience for me. I found it quite inspiring to hear about the diverse initiatives and research projects geared towards achieving health equity. Hearing from biomedical researchers, clinicians, public health providers, guideline developers, and medical societies truly showcased the depth of work in this field.

"My personal takeaway from the conference was on the power of collaboration. Successfully achieving the central goal of health equity integration would require all stakeholders, from providers & researchers to members of the very communities we aim to impact, actively sharing their perspectives. By engaging in consistent mutual learning, we can inspire innovation and translate our findings to actionable change across the entire medical ecosystem.

"As someone in guideline development, I particularly resonated with the work being done on pioneering a 'Population Conscious Analysis' approach to handling race and ethnicity as a variable in biomedical research. This innovation has me very optimistic about the positive impact it will have on new and existing quality appraisal tools being used in evidence synthesis.

"Lastly, I enjoyed engaging in discussions with poster presenters working on projects closely aligned with that of my team. Specifically, those focused on creating a race-conscious framework for for guideline development. These discussions reinforced the significant impact of the work we are engaged in."

Open the doors to opportunity:

Interested in contributing to the future of evidence-based medicine? Become an Evidence Foundation Scholar and attend our upcoming virtual fall workshop (October 29-31, 2025) for free. Application close August 31, 2025. See evidencefoundation.org/scholarships.html 

for application details.

Latest Evidence Foundation Scholar Tackles Project to Create New Quality Assessment Tool for Prevalence Studies

Prevalence studies inform understanding of an individual's baseline risk for a medical or health condition as well as the burden of the disease and the characteristics of a given target population. Meanwhile, estimates of the the absolute risk, taken from prevalence data, informs the development of evidence-based guidelines. But how can one tell if the data on prevalence are trustworthy or seriously biased?

There currently exists no widely agreed-upon tool to assess the risk of bias within studies of prevalence analogous to the Cochrane RoB 2.0 tool for randomized controlled trials or QUADAS-2 for studies of diagnostic test accuracy. Additionally, the assessment of a prevalence study comes with its own challenges, as it requires assessment of population selection, condition treatment, and analysis.

Dr. Ali Choaib, a post-doctoral research fellow in the Evidence-based Practice and Impact Center at the University of Kansas Medical Center, discussed this gap and his proposed project to address it as part of his presentation as the spring 2025 Evidence Foundation scholarship recipient.

At the GRADE Guideline Development Workshop held in Arlington, Virginia, last month, Dr. Choaib presented his work in systematically reviewing and thematically analyzing all existing tools to assess risk of bias in prevalence studies. Choaib and his team identified four major conceptual domains shared across the existing tools: study population, sampling, and setting; case/condition definition and measurement; statistical analysis; and other (e.g., conflicts of interest and missing data).

Next, Choaib's team will work to develop and receive iterative feedback on a new tool that assesses all critical domains while taking care not to include items or questions that are not specifically related to bias, such as those assessing reporting quality.

About his experience of the workshop, Choaib said, 

"The workshop was a perfect opportunity to learn, network, and collaborate with experts. Topics were dynamic and sessions tailored to individuals at all stages of the guideline development process from researchers to admins. I’m honored to have received the scholarship and to have contributed to discussions that expanded my knowledge and understanding of the guideline development process overall and with regards to diagnostic test accuracy specifically."

Choaib has additionally received the Encoding Health Equity Summit 2025 Travel Scholarship Program for Patients and Emerging Leaders. This scholarship, which is made possible with support from the Doris Duke Foundation, the Council of Medical Specialty Societies (CMSS), allowed him to attend the 2025 Encoding Health Equity Summit. This year's theme was "From Evidence to Impact."

"Encoding Health Equity Summit was an eye opening  and career influencing experience. Being a scholar and having the opportunity to contribute to the discussion on a novel and noble approach to health equity at a time when it’s needed. The meeting introduced us to other other investigators, administrators, journal editors, and society leaders broadened my perspective and opening the way for new opportunities and collaboration. This meeting has also connected ideas and work from basic science to implementation. It was inspiring to see so many passionate professionals working to advance equity and improve the future of health."

Interested in contributing to the future of evidence-based medicine? Become an Evidence Foundation Scholar and attend our upcoming virtual fall workshop (October 29-31, 2025) for free. Application close August 31, 2025. See evidencefoundation.org/scholarships.html for application details.

Learn more about Ali's project and other ways to get involved with GRADE at our upcoming free webinar, Monday, November 17th. Register to attend at this link.

USGN Congratulates Fall 2024 Scholar Michelle Hannum

The U.S. GRADE Network, in partnership with the Evidence Foundation, is proud to be able to offer scholarships for deserving applicants to attend our semi-annual GRADE Guideline Development Workshop with a waived registration fee. 

The scholarship allows workshop participants of all disciplines, fields, career stages, and backgrounds to learn about the GRADE framework for assessing certainty of evidence and formulating guideline recommendations. 

The fall 2024 scholarship recipient, Michelle Hannum, was chosen due to her proposed project on "The Promising Future of Evidence-Based Clinical Pathways in Reducing Healthcare Bias," undertaken as part of her work as a Guideline Development Project Manager at the Value Institute at the Medical University of South Carolina (MUSC) Health. The role of clinical pathways is to provide the right information (guideline recommendations) to the right people (electronic health record end-users) at the right time (based on patient data) in the right formats and using the right channels. Hannum presented data on pathway utilization at MUSC Health, which demonstrated that Heart Failure pathway utilization was approximately 16-18% and that utilization was equal across patient race/ethnicity and sex among this population. Furthermore, pathway utilization coincided with lower mortality rates, fewer 30-day readmissions and ICU days, and overall lower cost. 

When asked about her experience as a scholar, Hannum stated,

"The workshop does an outstanding job meeting individuals with where they are at in their GRADE journey, whether it be for career roles or personal goals. The information was presented in an engaging manner with plenty of opportunities for discussion and question-answering. The workshop provides an excellent foundation for understanding GRADE and its application."

Interested in being a scholar at the Spring 2025 GRADE Workshop in Washington, DC, May 7-9, 2025? Applications are due January 31. See details at www.evidencefoundation.org/scholarships/html.

EF Scholar Success Story: Nirjhar Ruth Ghosh

 New publication alert!

Nirjhar Ruth Ghosh, who attended the winter 2022 Systematic Review workshop as an Evidence Foundation scholar, recently published the results of her hard work in The Journal of Nutrition! The project, "Evidence-Based Practice Competencies Among Nutrition Professionals and Students: A Systematic Review" was originally presented by Ghosh to her fellow attendees of the virtual workshop. The results of the systematic review are now able to be read in detail at this link. 

In an accompanying editorial lauding the publication, Francene M. Steinberg wrote that "Ghosh et al. have provided a foundation for further consideration of steps to advance interprofessional competencies in EBP to optimize clinical nutrition decision making and patient care outcomes. Improved clarity about core competencies, innovative EBP curriculum and pedagogic approaches, and more rigorous research evaluations of EBP application and outcomes are all necessary components of the path forward."

Congratulations, Ruth!

Interested in being our next scholar success story? Applications for scholarships to attend our fully virtual GRADE Guideline Development Workshop are now open (deadline: August 31). Learn more at https://evidencefoundation.org/scholarships. 

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Three's a Crowd: How to Deal with More than Two Arms in a Meta-Analysis

It is not uncommon to come across the following scenario: when conducting a meta-analysis between two arms (e.g., an active therapy vs. a placebo), the meta-analyst includes a study that actually included two active arms (e.g., two different doses of the same experimental drug vs. placebo, two different routes of administration, etc.) Let's say that both of these arms were relevant to the clinical question. How should meta-analysis be undertaken in this case? A new tutorial article published in Cochrane Evidence Synthesis and Methods gives a primer on how to approach this common conundrum. 

Including the study twice in the forest plot – for instance, with one dose versus placebo and the other versus the same placebo group – is statistically problematic. It leads to a "unit of analysis" error by essentially "double-counting" the participants in the control group and violating the assumption that every individual participant is only counted twice. (Aside: this is also a common error in meta-analyses combining multiple similar outcomes – e.g., including the handgrip strength of both the dominant and non-dominant hand in the same forest plot – and risks committing the same violation unless advanced multi-level statistical techniques are used to account for this). 

This leaves two basic options for including the data from more than two study arms into the same forest plot: combining interventions that are similar, and splitting the control group in half. For instance, if the three groups in question are as such (assuming a dichotomous outcome):

• Experimental group A: 50 participants, 45 of whom had the event.
• Experimental group B: 50 participants, 41 of whom had the event.
• Control group: 50 participants, 22 of whom had the event.

These two experimental groups can either be combined (100 participants, 89 of whom had the event) and compared to the control group as-is, or they can be split out and compared (on separate lines of the forest plot) to half of the control group on each line:

• Experimental group A (45 out of 50) versus control (11 out of 25)
• Experimental group B (41 out of 50) versus control (11 out of 25).

Both approaches will yield very similar pooled results.

In the case of a continuous outcome, the same general approaches can be applied. However, if pooling two or more arms together, a pooled mean and SD will need to be calculated using the following equations from the Cochrane Handbook:

Reference: Axon, E., Dwan, K., & Richardson, R. (2023) Multiarm studies and how to handle them in a meta-analysis: A tutorial. Cochrane Evidence Synthesis and Methods. Available at publisher's website here.

Review of Time-to-Event Outcomes Analyzed in 50 Systematic Reviews Indicates Lack of Rigorous Reporting

Commonly used in the fields of oncology, cardiology, and others, time-to-event (TTE) outcomes assess not only the occurrence of an event but the amount of time that has lapsed leading up to its occurrence. For individuals in which the event did not occur, their time under observation is included.

TTE outcomes can provide useful insight into, for instance, into how long individuals survive when taking a new drug for advanced cancer. Statistical methods of calculating TTE outcomes include the use of curves and probabilities (Kaplan-Meier curves) and hazard ratios (HRs). 

In addition to being more statistically complex than a simple risk ratio, TTE outcomes are often not reported adequately enough in trials to be used in a meta-analysis without some amount of imputation or exclusion of data, which can introduce error.

In an article published in the July 2023 issue of Journal of Clinical Epidemiology, Goldkuhle and colleagues more closely examined the use of TTE outcomes in meta-analyses included in both Cochrane and non-Cochrane systematic reviews between 2017 and 2020. In the 50 included reviews, a median two TTE outcomes were included in meta-analyses, the most common being comparing the use of biologics and drugs in the treatment of neoplasms. 

However, a lack of clear reporting in the 235 trials informing these systematic reviews could easily lead to incomplete data. For instance, only 82% of the trials included a measure of follow-up duration. Information about missing data was only reported for each trial arm in 134 (57%) of the trials, and about one-third of trials reported no information at all in this respect. 

The authors conclude that trial authors using TTE outcomes should more stridently follow the Consolidated Standards of Reporting Trials (CONSORT) extension to trial outcomes, while specific guidance is needed for the reporting of meta-analysis of TTE outcomes. 

Goldkuhle, M. et al. (2023). Meta-epidemiological review identified variable reporting and handling of time-to-event analyses in publications of trials included in meta-analyses of systematic reviews. J Clin Epidemiol 159: 174-189.

The full-text publication can be accessed here.

McMaster and Guidelines International Network launch Collaboration Toolkit for Guideline Developers

Collaboration between medical professional societies and health organizations can increase the efficiency of development efforts, reduce waste, and help share resources, knowledge, and skills within and across disciplines. However, an international needs assessment of guideline developers found that certain aspects of collaboration were specifically challenging, including difficulties reconciling differences in guideline methodology and the time required for establishing collaboration agreements.

Since then, McMaster University and the Guidelines International Network (G-I-N) have worked on developing a toolkit for organizations looking to inspire, guide, and facilitate their own collaborations. The toolkit, launched at this year's G-I-N conference in Glasgow, Scotland, includes access to helpful resources such as a Memorandum of Understanding template for establishing partnerships and a glossary for making sure all parties are on the same page regarding important terms. A list of collaboration-related publications offers further knowledge and guidance for aspiring collaborators.

Check out the toolkit here and stay posted for update and additions!