Transcript Evidence Based Review

IAPCOI Subcommittee on
Evidence based
Recommendations (EBR)
2011-2013
IAPCOI Subcommittee on Evidence based
Recommendations (EBR): Formed on 24-25 Dec 2011
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Chair: T. Jacob John
Convener: Panna Choudhury
Co-Convener: Nitin Shah
Members: Vipin M. Vashishtha, Suhas Prabhu,
S. G. Kasi
• Expert advisors: HPS Sachdev; Piyush Gupta;
Dheeraj Shah
Aims and Objectives
• To develop a uniform approach to making explicit the
evidence base for IAPCOI recommendations
• To develop, evaluate and apply a system to make
evidence based recommendations (both existing and
future) for IAP COI.
IAPCOI subcommittee of EBR Meeting
Venue: IMA, New Delhi Date: 19-02-2012
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Dr. T. Jacob John), Dr. Vipin M Vashishtha;Dr. Panna Choudhury;Dr. H.P.S.
Sachdev;Dr. Piyush Gupta ;Dr. S.G. Kasi;Dr. Dheeraj;Dr. A.J. Chitkara
(Special Invitee); Dr. Shyam Kukreja (Special Invitee);
Dr. Nitin Shah (Co-Convener EBR) and Dr. Suhas Prabhu (Member EBR)
expressed inability to attend the meet.
Salient points of minutes (1):
Code of Conduct and Conflict of Interest
• EBR committee will follow code of conduct as decided by
IAPCOI……………….. all office bearers and members of
IAPCOI (including its subcommittees) should disclose any
financial, professional or other interests……..
• CIAP will appoint a committee of 3-5 eminent and neutral
persons to decide whether the competing interests are
significant enough to preclude the expert from participation in
the deliberations of IAPCOI
Salient points of minutes (2):
Guidelines for EBR to be followed
Guidelines for Evidence based
review are available from ACIP,
SAGE/WHO, ECDC. It was
agreed to broadly follow the
adapted
model
of
WHO
Guidelines. GRADE approach
would be followed for scoring
the quality of evidence. It is
noted that working group at
WHO requires 6-12 months for
addressing 1 recommendation,
ultimate
work
are
mostly
outsourced.
Salient points of minutes (3):
The key activities involved in creating evidence-based
recommendations by IAPCOI should be as follows
i) Definition of the questions to inform recommendations.
ii) Identification of the critical questions for which an in-depth review of
evidence is needed.
iii) Systematic review of the literature with or without meta-analysis.
iv) Review the quality of the evidence, in particular through assessment of the
risk of bias and confounding.
v) Scoring of the quality of the evidence (using the GRADE approach) for data
on safety and effectiveness.
vi) Discussion, deliberation and formulation of recommendation by IAP COI.
vii) Submission of recommendation of IAP COI to IAP EB.
Salient points of minutes (4):
Process….
• As per WHO Guidelines GRADE scoring can be done for no
more than 5 critical questions.
• IAPCOI also need to identify mechanism how these critical
questions would be addressed through GRADE approach
either by outsourcing or identifying person/persons
supported with reasonable remuneration or volunteers with
credibility in this field(It is pointed out that it is hugely costly
when outsourced ).
IAPCOI identified two specific issues:
Burden of Rotavirus diarrhea in India and
efficacy of current rotavirus vaccines in India
On 24th May, 2012 IAPCOI/CIAP identified persons
for doing the systematic review of burden of
rotavirus diarrhea in under five children.
Research Questions being addressed
• Identification of the proportion of diarrheal
diseases caused by rotavirus in hospitals
• Identification of the proportion of diarrheal
diseases caused by rotavirus in community
• Case fatality of rotavirus disease measured among
hospitalized children and community
• Identification of molecular epidemiology of
rotavirus diarrhea in under-five children of India’
Data Sources under Search
• The primary databases searched were Medline
through PubMed and IndMed
• Other sources including National Sample Survey,
WHO, UNICEF, National Family Health Survey and
Ministry of Health and Family Welfare
• Related articles and the reference lists of included
publications to identify additional studies
• Not included: any unpublished data, data available
within specific institutions at the national, state or
local level, or data unavailable in the public domain
TABLE I RESEARCH QUESTIONS AND SEARCH STRINGS USED
Q. No.
Research Question
Search string
PubMed
for
searching
1.
Burden of rotavirus in India among
under-five children
rotavirus AND india
(211 article)
2.
Burden of rotavirus diarrhea in India
among under-five children
3.
Epidemiology of rotavirus diarrhea in
India among under-five children
4.
Proportion of diarrheal diseases caused
by rotavirus in hospitals from different
parts of India
5.
Proportion of diarrheal diseases caused
by
rotavirus
in
community
from
different parts of India
6.
Case fatality of rotavirus disease in
India measured among hospitalized
children and community
(rotavius disease OR
rotavirus diarrhea OR
rotavirus gastroenteritis)
AND india
(206 article)
(epidemiology* OR burden
OR morbidity OR morbidity
OR mortality or incidence
OR prevalence OR profile)
AND (rotavirus OR rotavirus
diarrhea OR rotavirus
gastroenteritis OR rotavirus
disease) AND india
(147 article)
(epidemiology* OR burden
OR morbidity OR mortality
or incidence OR prevalence
OR profile OR hospital OR
nosocomial) AND (rotavirus
OR rotavirus diarrhea OR
rotavirus gastroenteritis OR
rotavirus disease) AND india
(167 article)
(epidemiology* OR burden
OR morbidity OR mortality
or incidence OR prevalence
OR profile OR community)
AND (rotavirus OR rotavirus
diarrhea OR rotavirus
gastroenteritis OR rotavirus
disease) AND india
(152 articles)
(epidemiology* OR burden
OR morbidity OR morbidity
OR mortality or incidence
OR prevalence OR profile
OR hospital OR community
OR case fatality) AND
(rotavirus OR rotavirus
diarrhea OR rotavirus
Search string for
No. searching
IndMed
rotavirus AND
india
rotavirus AND
india
rotavirus AND
india
rotavirus AND
india
rotavirus AND
india
rotavirus AND
india
• Full text articles have been analyzed in the
following format (Table 2)
TABLE 2 SUMMARY OF ARTICLES
Title
Methods
Participants
Interventions
Outcome
Conclusions