Browsing by Author "Guyatt, Gordon"

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    Low anonymous voting compliance with the novel policy for managing conflicts of interest implemented in the 9th version of the american college of chest physicians antithrombotic guidelines
    (Elsevier, 2013) Neumann, Ignacio; Akl, Elie; Valdes, Macarena; Bravo, Stephanie; Araos, Silvana; Kairouz, Kairouz; Schünemann, Holger; Guyatt, Gordon;
    BACKGROUND: The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a strategy to limit the impact of conflict of interest (COI) on recommendations. This policy excluded conflicted panelists from voting on recommendations with which they had conflicts. The objective of the study is to explore the compliance of the attendees of the AT9 final conference. METHODS: We conducted a survey and reviewed public declarations of COI of all the final AT9 conference attendees. For each of the controversies on which voting occurred (nine of 628 total recommendations), we estimated the compliance with COI policy as the proportion of attendees who recused themselves from voting on controversies for which they were conflicted. To evaluate the potential effect of noncompliance, we assumed that every vote cast by an ineligible conference attendee was cast in direction of the majority vote. RESULTS: Sixty-three panelists voted in at least one controversy at the final conference; the percentage of conflicted panelists varied from 6% to 39% for eight controversies. The compliance with the COI policy was 14 of 14 (100%) for one controversy, and varied from one of 19 (5%) to one of three (33%) in the remaining seven. In two of the eight controversies ("Compression device plus aspirin vs low-molecular-weight heparin in tromboprophylaxis in orthopedic surgery" and "Low-molecular-weight heparin vs vitamin K antagonists for treatment"), the low compliance may have affected the final recommendations. CONCLUSIONS: The low compliance raises concerns about implementation of COI restrictions in the context of anonymous voting.
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    Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
    (2023) Busse, Jason; Casassus, Rodrigo; Carrasco, Alonso; Durham, Justin; Mock, David; Zakrzewska, Joanna; Palmer, Carolyn; Samer, Caroline; Coen, Matteo; Guevremont, Bruno; Hoppe, Thomas; Guyatt, Gordon; Crandon, Holly; Yao, Liang; Sadeghirad, Behnam; Vandvik, Per; Siemieniuk, Reed; Lytvyn, Lyuba; Hunskaar, Birk; Agoritsas, Thomas
    Clinical question: What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)? Current practice: TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations. Recommendations: For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and β blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids. How this guideline was created: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective. The evidence: Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD. Understanding the recommendation: These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future

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