The field of guideline development has made considerable progress in the past twenty
years, particularly after the introduction of GRADE in 2004. However, there are many
shortcomings in current guideline development including failure to use GRADE, low
quality systematic reviews, and excessive delays from the publication of practice
changing evidence to new recommendations. The objective of this thesis is to describe
the development of evidence-based recommendations, to document methodological
issues that arose and describe how the research team addressed the questions, and to
document how the ultimate guidelines contributed to optimization of treatment in
clinical practice. The relevant guidelines address the issues of gastrointestinal bleeding
prophylaxis and coronavirus disease 2019 (COVID-19).
The thesis begins by presenting three methodological issues that arose during the
planning and implementation of the guideline process and the initial process of how the
research team addressed the challenges. The thesis subsequently presents a published
paper that documents recommendations regarding gastrointestinal bleeding prophylaxis
in critically ill patients. Then, this thesis presents a published systematic review and
meta-analysis addressing efficacy and safety of corticosteroids in COVID-19 based on
direct evidence from patients with COVID-19, and indirect evidence from acute
respiratory distress syndrome, community-acquired pneumonia, severe acute
respiratory syndrome, middle east respiratory syndrome and influenza. Further, the
thesis includes a published paper describing recommendations regarding corticosteroids, convalescent plasma and antiviral drugs in COVID-19 on the basis of evidence
available very early during the pandemic. This thesis ends by presenting how the
methodological issues were ultimately addressed in the relevant guidelines, the
importance of the guidelines themselves, and presents perspectives on future research
and opportunities in guideline development. / Thesis / Candidate in Philosophy
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26444 |
| Date | January 2021 |
| Creators | Ye, Zhikang |
| Contributors | Guyatt, Gordon, Clinical Health Sciences (Health Research Methodology) |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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