Searching for evidence in public health emergencies: a white paper of best practices

Objectives: Information professionals have supported medical providers, administrators and decision-makers, and guideline creators in the COVID-19 response. Searching COVID-19 literature presented new challenges, including the volume and heterogeneity of literature and the proliferation of new information sources, and exposed existing issues in metadata and publishing. An expert panel developed best practices, including recommendations, elaborations, and examples, for searching during public health emergencies. Methods: Project directors and advisors developed core elements from experience and literature. Experts, identified by affiliation with evidence synthesis groups, COVID-19 search experience, and nomination, responded to an online survey to reach consensus on core elements. Expert participants provided written responses to guiding questions. A synthesis of responses provided the foundation for focus group discussions. A writing group then drafted the best practices into a statement. Experts reviewed the statement prior to dissemination. Results: Twelve information professionals contributed to best practice recommendations on six elements: core resources, search strategies, publication types, transparency and reproducibility, collaboration, and conducting research. Underlying principles across recommendations include timeliness, openness, balance, preparedness, and responsiveness. Conclusions: The authors and experts anticipate the recommendations for searching for evidence during public health emergencies will help information specialists, librarians, evidence synthesis groups, researchers, and decision-makers respond to future public health emergencies, including but not limited to disease outbreaks. The recommendations complement existing guidance by addressing concerns specific to emergency response. The statement is intended as a living document. Future revisions should solicit input from a broader community and reflect conclusions of meta-research on COVID-19 and health emergencies

Long acting β(2 )agonists for stable chronic obstructive pulmonary disease with poor reversibility: a systematic review of randomised controlled trials

BACKGROUND: The long acting β2-agonists, salmeterol and formoterol, have been recommended, by some, as first line treatment of stable chronic obstructive pulmonary disease (COPD). We reviewed evidence of efficacy and safety when compared with placebo or anticholinergic agents in patients with poorly reversible COPD. METHODS: After searching MEDLINE, EMBASE, HealthSTAR, BIOSIS Previews, PASCAL, ToxFile, SciSearch, the Cochrane Library, and PubMed, as well as Web sites, selected journals, reference lists, and contacting drug manufacturers, two reviewers independently screened reports of randomised controlled trials of parallel or crossover design lasting four weeks or longer and including patients with a forced expiratory volume in one second (FEV1) ≤ 75% of predicted, a ratio of FEV1 to forced vital capacity (FVC) ≤ 88% of predicted, and < 15% improvement from baseline FEV1 after a dose of a β2 agonist. We included trials comparing salmeterol or formoterol with placebo or with ipratropium bromide and reporting one of these outcomes: lung function; exercise capacity; quality of life scores; dyspnea; exacerbations; rescue inhaler use; incidence of tachycardia, hypokalemia, or dry mouth. Two reviewers assessed the quality of included reports using the Jadad scale and allocation concealment, and abstracted data. RESULTS: Twelve trials satisfied our inclusion criteria; eight were high quality (Jadad score >2) and four were low quality (≤ 2). The adequacy of allocation concealment was unclear in all of them. We did not perform a meta-analysis due to differences in trial design and how outcomes were reported. Two trials comparing salmeterol with ipratropium did not detect differences; one trial comparing formoterol and ipratropium described greater improvement with formoterol in morning PEFR (15.3 versus 7.1 l/min, p = 0.040). Of twelve trials comparing long acting β2 agonists with placebo, six reported no improvement in exercise capacity, eleven reported improvements in FEV1 lung function (one reported no improvement), six reported less rescue inhaler usage (one reported no difference) and five reported improved dyspnea scores (two reported no improvement). Differences in quality of life were detected in one salmeterol trial ; however, two salmeterol, and one formoterol trial reported no differences. Adverse effects of interest were not reported. CONCLUSION: In terms of clinical outcomes and safety, we could not find convincing evidence that salmeterol and formoterol have demonstrated advantages to ipratropium, a less expensive drug, for patients with stable COPD and poor reversibility. Compared to placebo, we found evidence of reduced rescue inhaler usage and improved spirometric outcomes without a significant impact on quality of life or exercise capacity

Heart Failure: Is There a Role for Angiotensin II Receptor Blockers?

ABSTRACTAngiotensin-converting enzyme (ACE) inhibitors are currently considered the mainstay of treatment for heart failure because of their effects in decreasing morbidity and mortality. However, up to 10% of patients with heart failure may be intolerant of ACE inhibitor therapy because of intractable cough caused by these agents. The use of angiotensin II receptor blockers (ARBs) is now emerging for the management of heart failure in such patients. A literature review was undertaken to assess the clinical evidence available on the use of ARBs in the treatment of heart failure. Comparisons of these agents with ACE inhibitors in heart failure are growing but still limited. In particular, the effect of ARBs on morbidity and mortality is not clear. A recent meta-analysis of 17 clinical trials did not reveal any superiority of ARBs over ACE inhibitors in reducing either mortality or admission to hospital among patients with heart failure. On the basis of preliminary evidence, ARBs may be used in patients with heart failure who are intolerant of ACE inhibitors because of cough. Further research is required to more clearly define the role of these agents in the management of heart failure.RÉSUMÉLes inhibiteurs de l’enzyme de conversion de l’angiotensine (ECA) sont considérés actuellement comme la pierre angulaire du traitement de l’insuffisance cardiaque, parce qu’ils réduisent la morbidité et la mortalité. Cependant, jusqu’à 10 % des patients souffrant d’insuffisance cardiaque peuvent présenter une intolérance aux inhibiteurs de l’ECA, se manifestant par une toux rebelle. On a donc de plus en plus recours chez ces patients aux antagonistes des récepteurs de l’angiotensine II (ARA). Une revue de la littérature a été effectuée pour évaluer les données cliniques sur l’utilisation des ARA dans le traitement de l’insuffisance cardiaque. On trouve un nombre croissant, quoique limité, de données comparant ces agents aux inhibiteurs de l’ECA dans le traitement de l’insuffisance cardiaque. Plus précisément, les effets des ARA sur la morbidité et la mortalité ne sont pas clairs. D’ailleurs, une méta-analyse récente de 17 essais cliniques n’a pu démontrer que les ARA exerçaient un effet supérieur aux inhibiteurs de l’ECA sur la réduction de la mortalité ou des hospitalisations chez les patients atteints d’insuffisance cardiaque. Ces données préliminaires permettent de conclure que les ARA peuvent être utilisés chez les patients souffrant d’insuffisance cardiaque et qui présentent une intolérance aux inhibiteurs de l’ECA se manifestant par une toux. D’autres recherches sont nécessaires pour définir plus clairement le rôle de ces agents dans le traitement de l’insuffisance cardiaque

The Current Status of Autotitrating Continuous Positive Airway Pressure Systems in the Management of Obstructive Sleep Apnea

BACKGROUND: Autotitrating continuous positive airway pressure (APAP) devices have the potential to address some of the disadvantages of titration and treatment with conventional continuous positive airway pressure (CPAP). Information on the performance of APAP in clinical use is still comparatively limited

Best Practices for Searching During a Public Health Emergency

This project aims to develop a broad, living document of best practices for searching in a public health emergency to support the needs of medical providers, health care administrators, public health experts, and those providing guidance