Second USGN Systematic Review Workshop Features a Record Nine Scholars From Around the Globe

Earlier this month, the U.S. GRADE Network held its second two-day, comprehensive, all-virtual systematic review workshop. This workshop allowed participants to learn about each step of the systematic review process, from designing a search strategy to meta-analysis to preparing a manuscript for publication. True to USGN style, the workshops consisted of a mixture of large-group lectures and smaller-group experiential learning components in which participants received a tutorial of Rayyan (a free online screening tool), assessed studies for risk of bias, and created risk of bias and forest plots in Cochrane's Review Manager software.

Uniquely, this workshop featured nine Evidence Foundation scholars who attended the workshop free of charge. As part of their applications for this scholarship, these participants described a proposed or current systematic review project related to health care, with a preference given to projects aimed at addressing inequities or with a focus on underserved populations. The nine accepted applicants provided a diverse array of exciting projects - from HIV pre-exposure prophylaxis to interventions for rabies control to weight-bearing exercise in pregnant patients - and hailed from across the globe, from Canada and Benin to Turkey, Syria, Dubai, and Kazakhstan.

Be the first to hear about these and other trainings @USGRADEnet on twitter or at www.systematicreview.org.

Note: applications for scholarships to attend the upcoming GRADE Guideline Development Workshop, held virtually November 30 - December 2, 2022, close September 30. See application details here.

U.S. GRADE Network Holds Its First Two-Day Systematic Review Workshop

In response to popular demand, the U.S. GRADE Network recently expanded its half-day course on systematic reviews into a two-day virtual workshop. Taking place over February 1-2, 2022, the sessions comprised six total hours of instructional time and question-and-answer sessions with Network faculty in addition to three hours of hands-on activities in a small-group format. Large-group lectures ranged from developing a focused clinical question to conducting meta-analysis and evaluating the quality of systematic reviews. In hands-on sessions of ten participants each, attendees were introduced to a free online screening platform (Rayyan) and tried their hands at assessing risk of bias and conducting meta-analysis in RevMan, a free systematic review and meta-analysis software from Cochrane.

As part of the program, the Evidence Foundation welcomed three recipients of scholarships to attend the workshop free of charge. As part of their applications, the scholars described a current or proposed project for a systematic review. The three recipients, along with their projects, included:

• Bryden Giving, MAOT, OTR/L (Boston University): A traffic light of evidence for occupational therapy interventions supporting autistic children and youth
• Nirjhar Ruth Ghosh, MS (Texas A&M University): Evidence-based practice in the field of nutrition: A systematic review of knowledge, skills, attitudes, behaviors and teaching strategies
• Milton A. Romero-Robles (Universidad Nacional del Santa): Participation, involvement and main barriers in the inclusion of patients with non-communicable diseases in the development of clinical practice guidelines: A systematic review protocol

Be the first to hear about these and other trainings @USGRADEnet on twitter or at www.systematicreview.org.

Note: applications for scholarships to attend the upcoming GRADE Guideline Development Workshop held July 29-July, 2022, in Chicago, Illinois, close March 31. See application details here.

Evidence Foundation Scholar Update

Contributed by Janice Tufte, 2019 Evidence Foundation Scholar & Madelin Siedler, 2019/2020 U.S. GRADE Network Research Fellow

Janice Tufte, an independent consultant and a leader in patient-public partnership initiatives, received a scholarship to attend the tenth GRADE guideline development workshop held in Denver, Colorado in February 2019 (blog post here). As part of her scholarship, Tufte presented to the larger workshop group on the unique opportunities of using patient partners during the development of GRADE guidelines.

Spring 2019 scholarship recipients: Dr. Irbaz bin Riaz (L) and Ms. Janice Tufte (R)

Tufte has worked with the American College of Physicians as a public panel member on multiple guidelines in addition to serving as a panel member of their Clinical Guidelines Committee. In these roles, she has provided input on outcomes of importance and on future topics for guideline development and is listed as a co-author on recent guidelines and guidance statements. She has also presented to groups on the basics of guideline development including fellow ambassadors of the Patient-Centers Outcomes Research Institute (PCORI).

Recently, Tufte co-published a protocol for the development of guidance for multi-stakeholder engagement (MuSE) in health and healthcare guideline development and implementation. The forthcoming guidance will be based on four different systematic reviews, including an examination of the current barriers and opportunities for stakeholder involvement in the guideline development process and the effect of stakeholder engagement on resulting guidelines and their implementation. The project will ultimately provide recommendations for ways to improve stakeholder engagement.

Here, Tufte provides an update on her work to continue to promote patient involvement in guideline development, including the use of GRADEpro software for these purposes.

My first exposure to the GRADE process and subsequent utilization of the GRADEpro platform genuinely captured and kept my attention. I quickly realized how beneficial both the Evidence to Decision and Summary Tables could be to public patients involved with systematic reviews, guideline development, and recommendations. I could view the overall landscape and better comprehend the pertinent information and findings in the EtD and Summary table that I needed as a non-scientist, allowing me to contribute more effectively in a meaningful manner in a panel conversation on evidence, recommendations or judgements.

GRADEpro is a versatile and modifiable online format. We are able to create a foundation based on the specificities and needs unique to our individual question that will then display the evidence and quality syntheses in a neat table as well as a reliable summary. Having diverse stakeholders at the table is important. Encouraging all to bring in the public and patient perspective is my particular favorite niche, and I will continue to promote this no matter the topic area.

I have recently enjoyed working with the new GRADEpro extensions while serving on a guidelines panel, where we have incorporated GRADE infographics. One challenge I have discovered is synthesizing the information down to an easy understandable one-pager for both clinicians and public reading.

I am looking forward to working with GRADE in the future, with a goal to better deliver reliable, understandable evidence to all who could benefit.

Stay tuned for future updates regarding Janice’s continued work in promoting patient engagement in guideline development.

If you are interested in learning more about GRADE and attending the workshop as a scholarship recipient, applications for our upcoming workshop in Chicago this October are open. The deadline to apply is July 31, 2020. Details can be found here.

Fall 2019 - Scholarship recipients

Contributed by Madelin Siedler, 2019/2020 U.S. GRADE Network Research Fellow

The Eleventh GRADE Guideline Development Workshop was held in Orlando, Florida, this past September. This workshop welcomed 52 participants, including several international attendees from Canada and Brazil. Among these participants were three recipients of a scholarship provided by the Evidence Foundation, which covers the cost of registration. Coming from diverse backgrounds ranging from organizational work to evidence synthesis to policymaking, scholars Faduma Gure, Eric Linskens, and Christian Kershaw presented their proposals for new innovations or opportunities for improving the application and implementation of evidence-based medicine.

Faduma Gure, MSc, a knowledge translation and research specialist for the Association of Ontario Midwives, discussed the challenges of incorporating client perspectives to midwifery guidelines for the organization, which utilizes the GRADE approach. Pregnancy through the post-partum period is often a tumultuous time filled with decision-making, Gure explained, and more can be done to better understand the values and preferences of midwifery clients and to employ an equity lens when formulating recommendations. Gure proposed a solution that includes the development of an equity advisory group consisting of key stakeholders representative of Ontario’s population of midwifery clients. The organization could then involve these stakeholders through the entire guideline development process - from the initial setting of research priorities to the ultimate formulation of recommendations - and elicit important feedback about patient values and preferences as well as the potential impacts of a guideline on various communities.

Eric Linskens, BSc, serves the Minneapolis Veterans Affairs Evidence Synthesis Program and the Minnesota Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center. Linskens presented his current work applying the GRADE approach to existing systematic reviews which did not originally use GRADE. Linskens discussed some of the challenges that his team has faced as part of the initiative, as well as innovative solutions to these issues. For instance, a systematic review conducted by AHRQ may automatically rate down for inconsistency due simply to the inclusion of a sole study, whereas in the GRADE approach, this would not be the case. Additionally, an existing review may break down one clinical question into multiple smaller analyses of comparators or sub-populations, whereas it would be more clinically relevant to use these data to create one larger recommendation. To best solve these issues, Linskens noted, it is important to consider the end-user of any given review or guideline so that their needs can be best met. Additionally, transparently reporting all judgments around the analyses is key. Regarding his time at the workshop, Linskens said, “[i]t was very helpful to work through examples with the GRADE workshop facilitators in small group sessions. They answered our questions as they came up.”

Christian Kershaw, PhD, is a molecular neuroscientist who now works as a health policy analyst for CGS, a Medicare fee-for-service contractor. Dr. Kershaw used her personal experience transitioning from bench science to policymaking to inspire her presentation on the utility of cross-functional teams in medicine and healthcare policy. To develop a cross-functional team, Dr. Kershaw explained, it is best to identify a problem that would best be solved by a group of individuals with heterogeneous skills and backgrounds that would each uniquely serve a common goal or purpose. As an example, Kershaw discussed the development of a team to standardize the way information is used to form coverage decisions as part of the 21st Century Cures Act. The team is comprised of a medical doctor to understand the need for and content of the policies; an outreach and education specialist to understand their legal implications; and a basic research scientist to compile and assess the information. Leveraging individual team members’ strengths and encouraging innovation are keys to success when working in a cross-functional team. “I was impressed with the versatility of the GRADE framework,” Kershaw noted. “It was very informative to learn all of the different ways that the conference attendees were using GRADE to suit their projects.”

If interested in applying for a scholarship to future GRADE workshops, more details can be found here: https://evidencefoundation.org/scholarships.html. Please note the deadline for applications to our next workshop in Phoenix, AZ will be December 4, 2019.

Fall 2018 Scholarship Recipients

Contributed by Madelin Siedler, 2018/2019 U.S GRADE Network Research Fellow

We were pleased to support the participation of three research scholars at our recent GRADE guideline development workshop held in Silver Spring, Maryland, October 17-19, 2018. By providing complementary registration, we hope that these scholars increased their understanding and application of the GRADE approach. As part of the U.S. GRADE Network/Evidence Foundation scholarship, recipients presented to fellow workshop participants about their interests and current endeavors in the field of guideline development.

Scholarship recipients: Oilvia Magwood, Mohamad Kalot, and Mohammed Alkhatib

A few details about our Fall 2018 scholarship recipients:

Mohamad Kalot, MD, a postdoctoral research fellow at University of Kansas Medical Center, Kansas City, Kansas, applied for the scholarship due to his interest in improving quality and decreasing disparities in healthcare through the development of evidence-based guidelines. Dr. Kalot presented on his current work in the development of guidelines for the management of rare diseases. Dr. Kalot explained how the development of such guidelines presents a unique challenge in that there is often a dearth of research on these populations, which can affect the directness of evidence among other factors.

“Since an important part of my conducted reviews and research deals with developing guidelines for rare diseases, I would ultimately face specific challenges in the process of assessing the certainty of evidence in my work, and I’m interested in exploring innovative methods to deal with these challenges,” said Kalot. “The GRADE workshop in Silver Spring didn’t only help me find solutions for my challenges, it made me see the research methodology world from a different, deeper and more practical perspective - especially with the very helpful tools [RevMan and GRADEpro Guideline Development Tool] that we learned about in the small groups sessions and the discussions about rating up and rating down the quality of evidence.”

Olivia Magwood, MPH, attended from the Buyere Research Institute in Ottawa, Ontario, where she has participated in the development of three national and international guidelines. Ms. Magwood presented on the development of the FACE (Feasibility, Acceptability, Cost, and Equity) Framework Stakeholder Survey. The FACE Stakeholder Survey aims to identify cognitive bias that may influence guideline development as well as inform the quality and impact and improve the uptake of evidence-based recommendations in various stakeholder groups.

“For me, the GRADE workshop highlighted the importance of building my network and having the right people on your team throughout the guideline development process,” explained Magwood. “This includes involving methodologists early and throughout guideline development, as well as emphasizing patient perspectives, especially while deciding on patient-important outcomes. Guideline development is truly a collaborative process that benefits from multi-stakeholder engagement.”

Mohammed Alkhatib, MD, a postdoctoral research fellow at University of Kansas Medical Center, Kansas City, Kansas, applied for the scholarship due to his interest in examining and refining the adoption, adaptation and de novo development (or “adolopment,” for short) of guidelines to be used in lower-resource settings. Dr. Alkhatib presented on the importance of this approach, as well as the unique challenges of tailoring the development of clinical recommendations to settings with limited resources, such as developing nations and areas of conflict.

“It was an exceptional experience for me to present my proposal in front of high-level scholars of guideline development and to listen to their positive feedback,” said Alkhatib. “[The] GRADE workshop was very helpful for me at the level of interpretation of [systematic reviews] and how to judge strengths and weaknesses using GRADEpro.”

**If interested in applying for a scholarship to future GRADE workshops, more details can be found here: https://evidencefoundation.org/scholarships.html. Please note the deadline for applications to our next workshop in Denver, Colorado will be January 1, 2019.

Scholarship Announcement for Next Guideline Development Workshop

Scholarship Opportunity Available for the Guideline Development Workshop

The U.S. GRADE Network in collaboration with Evidence Foundation is pleased to offer a scholarship program primarily for participants from North America for attendance of the Guideline Development Workshop in Orlando, FL. Recipients will be awarded a waived registration fee funded by the Evidence Foundation. The U.S. GRADE Network is now accepting applications (deadline: 8/31/2016).

Application: 500 words (or less) describing an innovation in guideline development, implementation, or teaching with the goal of reducing bias in health care recommendations. The innovation could be a future idea or proposal, or one that has already been implemented. The selected applicants will be given the opportunity to provide a 5-10 minute oral presentation to inform audience about their idea or project.

Candidates: New to GRADE without prior GRADE workshop attendance. Early involvement in guideline development (not based on age or experience). Access to a GRADE mentor following the workshop is a plus. The U.S. GRADE Network may be able to help identify a GRADE mentor.

Travel and lodging: Applicant’s institution pays for travel and lodging.

Application deadline: Please send application with a letter of support from your institution by August 31st, 2016 to US@gradeworkinggroup.org

Announcing the U.S. GRADE Network!

The GRADE Working Group was established in 2000 "as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health care. The working group has developed a common, sensible and transparent approach to grading quality of evidence and strength of recommendations."
Fifteen years and hundreds of publications later, the GRADE approach for evidence assessment and recommendation development has been adopted by over 90 international organizations. In order to facilitate the adoption and tailor development of guideline methods to audiences in the U.S., we established the U.S. GRADE Network in 2014.

The U.S. GRADE Network aims to provide regular workshops on guideline development using the GRADE approach, as well as collaborate with U.S.-based individuals and organizations interested in exploring research priorities within the healthcare system. We will also work to connect individuals and professional societies interested in developing guidelines with trained methodologists to support and guide the process.

We look forward to collaborating with you!