To maximize the efficiency of resources and reduce redundancy, organizations and countries may decide to adapt an existing practice guideline rather than developing a new one. The RIGHT (Reporting Items for practice Guidelines in HealThcare) statement currently informs the reporting of the guideline development; however, it does not cover reporting of steps that are specific to guideline adaptation.
A scientific workgroup, filled this gap and developed a new reporting tool designed to improve standardization and transparency of adapted health care guidelines. Called the RIGHT-Ad@pt Checklist, the tool focuses on improving the clarity and explicitness of recommendations that have been adapted for use in different health care systems, and of the guideline development process.
The RIGHT-Ad@pt Checklist was developed as an extension of the RIGHT statement through a multi-step process involving literature reviews and consensus building involving a range of stakeholders including guideline adaptation experts, users, journal editors, and policy makers. The checklist was designed to be used to guide the reporting of adapted guidelines, including adaptation process and the adapted recommendations. It can also be applied to assess the completeness of reporting and, in combination with available adaptation frameworks, to inform adaptation processes. Different audiences may use the RIGHT-Ad@pt checklist for different purposes:
Guideline developers could use the checklist to report their adapted guidelines;
Journal editors and reviewers could use the checklist to ensure the completeness and transparency of the reporting in the publication of adapted guidelines;
Clinicians could accurately identify and apply adapted recommendations to their clinical practice based on detailed and clear reporting; and
Policymakers could evaluate the feasibility of adapted recommendations for local implementation based on the reporting contents suggested by the checklist.
The checklist was published in Annals of Internal Medicine and is available here
Convalescent plasma has a long history in treatment of infectious diseases – being used when other therapies are available .The use of plasma from patients who have recovered from COVID-19 was used similarly as it can neutralize viral particles and hence help patient care. But many randomized controlled trials have now been completed and it is time now for using evidence to inform not only clinical care but also future research.
The talk will have presentation’s from Dr Aparna Mukherjee (ICMR) and Professor Peter Horby ( Oxford University) and Dr Soumyadeep Bhaumik (The George Institute for Global Health, India). The seminar is moderated by Bharath Kumar Tirupakuzhi Vijayaraghavan (Apollo Hospitals, India)
Dr Soumyadeep Bhaumik will talk about ” From trials to the bedside: convalescent plasma during the COVID-19 pandemic”
Abstract of talk
The use of convalescent plasma in hospitalized COVID-19 patients has started from the beginning of the pandemic. However, during the second wave of the COVID-19 pandemic – with a failing health system , with exhausted doctors and desperate patients – this meant widespread irrational use . Patient and care-givers had to run pillar-to-post to secure plasma from COVID-survivors. The national guidelines remained unchanged and many doctors were confident about its utility . I will discuss the sum-total of evidence (from a systematic review), discuss about how confident we are about the results (through GRADE), and put it in the evidence-to-decision framework in the Indian context. I will also touch on problems in our current guidelines which exist in form of mere flowcharts.
Event is free to attend but requires pre-registration: Click
On 22nd April 2021 in the midst of a crumbling health system the AIIMS/ ICMR-COVID-19 National Task Force/Joint Monitoring Group , Ministry of Health & Family Welfare has finally issued a revised “Clinical Guidance for Management of Adult COVID-19 patients” (* see post-publication note in end). In essence, it is not much of a guideline but a flowchart (much like the previous one). It does not adhering to any standards of a guideline, does not present any evidence (not even citations!), nor does it communicate anything around risk-benefits for any of the drugs. As such, it is impossible to understand how the guideline was developed and why some drugs were chosen and why it was not.
The article however focusses only on one aspect of the guidelines- the recommendation for hydroxychloroquine being recommended as a “may do” . However, this recommendation for hydroxychloroquine is contrary to data from randomized controlled trial. Between July 2020 (when the last guideline was issued) and now, there is a lot of trials that has been completed and we now have reasonable evidence to inform decision making. Evidence from randomized controlled trial shows that hydroxychloroquine does do not have any effect on mortality (based on data from 10859 patients ; 29 studies) in COVID=19 patients . In fact patients given hydroxychloroquine may have significantly more diarrhea , nausea and vomiting compared to those not given so. Diarrhoea and vomiting are known to increase the risk of hypovolaemia, hypotension and acute kidney injury, additional health systems burdens which one should avoided at all costs in this phase of the pandemic.
Even if we look at health systems relevant outcomes (which are of course equally important to patients) which are of significance in the currently crumbling health system recommending the use of hydroxychloroquine does not make any sense – it increases the number of people who need mechanical ventilation(based on data from 6379 patients ;5 studies).
*As of 10th May 2021 – another version of the AIIMS/ICMR guideline is being circulated in social media without hydroxychloroquine . I could not verify the veracity of this version of guideline being genuine considering the ICMR website https://www.icmr.gov.in/ still hosts the 22nd April 2021 version