Introduction to<i>BMJ</i>Rapid Recommendations

Siemieniuk, Reed; Agoritsas, Thomas; Macdonald, Helen; Guyatt, Gordon; Brandt, Linn; Vandvik, Per Olav

doi:10.1136/bmj.i5191

Cited by 111 publications

(154 citation statements)

References 8 publications

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“…According to the BMJ Rapid Recommendations process,15 a guideline panel provided critical oversight to the review and identified populations, subgroups, and outcomes of interest. The panel included clinicians, methodologists, and patients with experience of sore throat.…”

Section: Methodsmentioning

confidence: 99%

“…The aim of the project is to respond to new potentially practice changing evidence and provide a trustworthy practice guideline in a timely manner 15. In this case, the stimulus was the recent TOAST (Treatment Options without Antibiotics for Sore Throat) trial, which randomised over 500 patients with sore throat presenting to their primary care clinician who were not initially prescribed antibiotics; the TOAST authors reported beneficial effects of corticosteroids 16.…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

Sadeghirad

Siemieniuk

Brignardello‐Petersen

et al. 2017

BMJ

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Objective To estimate the benefits and harms of using corticosteroids as an adjunct treatment for sore throat. Design Systematic review and meta-analysis of randomised control trials. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries up to May 2017, reference lists of eligible trials, related reviews. Study selection Randomised controlled trials of the addition of corticosteroids to standard clinical care for patients aged 5 or older in emergency department and primary care settings with clinical signs of acute tonsillitis, pharyngitis, or the clinical syndrome of sore throat. Trials were included irrespective of language or publication status. Review methods Reviewers identified studies, extracted data, and assessed the quality of the evidence, independently and in duplicate. A parallel guideline committee (BMJ Rapid Recommendation) provided input on the design and interpretation of the systematic review, including the selection of outcomes important to patients. Random effects model was used for meta-analyses. Quality of evidence was assessed with the GRADE approach. Results 10 eligible trials enrolled 1426 individuals. Patients who received single low dose corticosteroids (the most common intervention was oral dexamethasone with a maximum dose of 10 mg) were twice as likely to experience pain relief after 24 hours (relative risk 2.2, 95% confidence interval 1.2 to 4.3; risk difference 12.4%; moderate quality evidence) and 1.5 times more likely to have no pain at 48 hours (1.5, 1.3 to 1.8; risk difference 18.3%; high quality). The mean time to onset of pain relief in patients treated with corticosteroids was 4.8 hours earlier (95% confidence interval −1.9 to −7.8; moderate quality) and the mean time to complete resolution of pain was 11.1 hours earlier (−0.4 to −21.8; low quality) than in those treated with placebo. The absolute pain reduction at 24 hours (visual analogue scale 0-10) was greater in patients treated with corticosteroids (mean difference 1.3, 95% confidence interval 0.7 to 1.9; moderate quality). Nine of the 10 trials sought information regarding adverse events. Six studies reported no adverse effects, and three studies reported few adverse events, which were mostly complications related to disease, with a similar incidence in both groups. Conclusion Single low dose corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects. Included trials did not assess the potential risks of larger cumulative doses in patients with recurrent episodes of acute sore throat. Systematic review registration PROSPERO CRD42017067808.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

Sadeghirad

Siemieniuk

Brignardello‐Petersen

et al. 2017

BMJ

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“…magicproject.org) called WikiRecs-''Wiki'' means ''rapid'' in Hawaiian-modelled after the new BMJ series, ''Rapid Recommendations''. 4,5 A recently published randomized trial addressed an important topic, i.e., optimal blood pressure targets in critically ill patients. 6 In response, the leaders of the Critical Care-WikiRecs group developed a rapid clinical practice guideline by following the WikiRecs process.…”

mentioning

confidence: 99%

“…6 In response, the leaders of the Critical Care-WikiRecs group developed a rapid clinical practice guideline by following the WikiRecs process. 4 The process starts when the WikiRecs team identifies a new study that might initiate a change in practice. A guideline panel then convenes to determine which populations, outcomes, and subgroups to consider.…”

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confidence: 99%

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The next frontier in critical care guidelines: rapid and trustworthy recommendations

Siemieniuk

Guyatt

2017

Can J Anesth/J Can Anesth

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How to Interpret and Use a Clinical Practice Guideline or Recommendation

Brignardello‐Petersen

Carrasco-Labra

Guyatt

2021

JAMA

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IMPORTANCEClinicians may rely on recommendations from clinical practice guidelines for management of patients.OBSERVATIONS A clinical practice guideline is a published statement that includes recommendations that are intended to optimize patient care. In the guideline development process, a panel of experts formulates recommendation questions that guide the retrieval of evidence that is used to inform the recommendations. Typically, methods of guideline development, a summary of the supporting evidence, and a justification of the panel's decisions accompany the recommendations. To use such guidelines optimally, clinicians must understand the implications of the recommendations, assess the trustworthiness of the development process, and evaluate the extent to which the recommendations are applicable to patients in their practice settings. Helpful recommendations are clear and actionable, and explicitly specify whether they are strong or weak, are appropriate for all patients, or depend on individual patients' circumstances and values. Rigorous guidelines and recommendations are informed by appropriately conducted, up-to-date systematic reviews that consider outcomes important to patients. Because judgments are involved in the interpretation of the evidence and the process of moving from evidence to recommendations, useful guidelines consider all relevant factors that have a bearing in a clinical decision and are not influenced by conflicts of interest. CONCLUSIONS AND RELEVANCEIn considering a guideline's recommendations, clinicians must decide whether there are important differences between the factors the guideline panel has considered in making recommendations and their own practice setting.

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Introduction toBMJRapid Recommendations

Cited by 111 publications

References 8 publications

Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

The next frontier in critical care guidelines: rapid and trustworthy recommendations

How to Interpret and Use a Clinical Practice Guideline or Recommendation

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