Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025 A Midcourse Report (2022) / Chapter Skim
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Appendix E: Summary of Selected Systematic Review Practices
Appendix E: Summary of Selected Systematic Review Practices
Pages 239-256
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From page 239... ...
. The practices used by these organizations are summarized under the column "Committee-Identified Practices." In addition, the committee summarized NESR systematic review practices used in the 2020 Dietary Guidelines for 1 The title of this appendix was modified after release of a prepublication version of the report to the sponsor to clarify that these are selected examples of systematic review practices and that these are based on the committee's identified sources and are not standardized.
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. TABLE E-1 Systematic Review Practices Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta Transparency • Cochrane requires • Systematic • Partially registration of full review protocol implemented systematic review components protocols through related to PROSPERO question, • PROSPERO analytical registered framework and protocols include search strategy title, description (and associated of participants changes)
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APPENDIX E 241 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta • Original protocols • Data extrac- • Likely to have remain publicly tion, coding and minor impact on available and are analysis plan were systematic review cited in the final not included in results systematic review publicly available • Could have major to optimize trans- protocols during impact on trans parency DGAC delibera- parency and pub • Final reports/pub- tions lic perception of lications should • Originally ap- integrity clearly identify proved search any changes to plan protocol the original proto- documents are no cols and include a longer publicly rationale for those available changes • Final protocols do not include dates of which minutes addressed the changes • Detail regarding search plan proto col changes vary between systemat ic review reports and the Scientific Report of DGAC 2020 continued
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242 EVALUATING THE PROCESS TO DEVELOP THE DGA, 2020–2025 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta Managing • Cochrane • Guidelines • Implemented conflict mandates that for handling at individual of interest authors report all disclosure of COI participant level potential forms of in selection of COI going back at the DGAC have least 3 years been described in • IOM and the 2020 DGAC Cochrane Scientific Report highlight the • COI is need to manage coordinated by COI that might the USDA or diminish HHS Committee credibility of Management the findings Officer as part of of individual each member's participants vetting process using guidance provided by the U.S. Office of Government Ethics • COI are reviewed semi-annually • All individuals with a substantive role in a NESR systematic review project, including NESR staff and external experts, submit a curriculum vitae and disclose potential COI
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APPENDIX E 243 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta • IOM indicates • Information • Emerging area that bias may on managing could have be conscious or institutional major impact on unconscious and conflict of interest transparency and influence choices for research public perception made throughout performing and of integrity the process research funding • Literature is organizations is emerging on best not available ways to manage institutional conflict of interest for research performing and research funding organizations • Funders should have no role in Clinical Practice Guideline development continued
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• ODS takes a simi- identified the lar approach and broad topics specifically high- and questions to lights using an address iterative approach • The DGAC to refining review set priorities questions, ana- and refined lytical framework, the questions and framing of in an iterative research question process with (population, inter- NESR; DGAC vention, control created analytical and outcomes framework for [PICO]
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APPENDIX E 245 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta • Formulation of the research ques tions and PICO framework are peer reviewed by content and systematic review experts at the systematic review protocol stage • Any changes made after sys tematic review protocol approval are transparently documented in the published full review • When systematic reviews are con ducted specifically to inform particu lar guidelines, the guideline devel opment group and systematic review team should inter act regarding the scope, approach, and output of both processes continued
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246 EVALUATING THE PROCESS TO DEVELOP THE DGA, 2020–2025 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta Search • Search strategies • Overall search • Partially Strategy that are tailored to strategy formed a implemented the various data- priori by NESR (more detail in bases created by • Search strategies task 2, peer review librarians trained tailored for each addressed laterb) in systematic systematic review review training are created by a • Search strategies NESR systematic are externally review librarian peer reviewed as • Search strategies part of systematic are peer reviewed review protocol by a second review internal NESR • Search strategy re- librarian but are sults are captured not reviewed by at each stage of an external peer the search in flow review at the diagrams systematic review protocol stage • Search strategy results are captured and reported at each step
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and DistillerSR software ensured that common data elements were captured in a similar way across all systematic reviews continued
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. related systematic NESR considers reviews, although potential for these generally publication bias include interven- in the evidence tion research synthesis process • Funding is specifi- by considering cally excluded as the extensiveness a source of bias of the search, and and in validated whether large risk of bias tools, and small studies but can be ex- were included tracted as part of in the review, in characteristics of particular small the study.
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• The significant • AHRQ process • NESR has differences includes five grade informed from GRADE is domains: study predefined the absence of limitations, direct- criteria, based publication bias ness, consistency, on 5 grading with major impact precision, and elements that the on systematic reporting bias committee used review outcomes • Cochrane uses the to evaluate and if the NESR GRADE approach, grade the strength processes are which "involves of the evidence not continually 5 criteria to as- supporting updated and sess certainty of each conclusion adapted evidence: risk of statement. The 5 bias, consistency grading elements of effect, impreci- are risk of bias, sion, indirectness consistency, of effect, and directness, publication bias" precision, and • Use the online generalizability GRADEpro tool of the evidence.
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250 EVALUATING THE PROCESS TO DEVELOP THE DGA, 2020–2025 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta Creating • Description of • The NESR • Partially Recommenda- formal consensus analysts drafted a implemented tions from processes and description of the Conclusion how to effectively studies included Statements use the analyti- in the systematic cal framework to review to begin evaluate both ben- the process of efits and harms synthesizing and arrive at the evidence. recommendations This description as well as the fol- included lowing statement information about the study designs, sample sizes (i.e., baseline and analytic sample size, attrition)
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May estimating the or more summary lead to different magnitude of statement(s) questions benefit, harm, and carefully and topics for net benefit and constructed systematic reviews certainty of net to answer the benefit systematic review • Rationale state- question ment (summa- • The NESR rizes benefits and methodology harms, why out- includes comes are deemed considerations for important, as- making decisions; sumptions about however, it does relationships, not describe nature of evidence how the formal [quantity and consensus process consistency, and will be conducted gaps]
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252 EVALUATING THE PROCESS TO DEVELOP THE DGA, 2020–2025 TABLE E-1 Continued Committee-Identified NESR 2020 Implementation Practice Practices DGA cycle Impacta Updating • Cochrane general- • Decision • Partially Systematic ly expects updates regarding whether implemented Reviews within 5 years and an existing • Less detailed specifies a pro- systematic review descriptions are cess for updating would be used provided reviews including or updated was • Major decisions around after the DGAC improvements whether the re- developed are possible view question is their protocol in describing, still valid and analytical implementing, • Cochrane con- framework at the and documenting cluded that "Add- 5-year mark decision-making ing new studies • Existing NESR processes for and new data systematic using/updating can substantively reviews were existing systematic change the find- compared to the reviews ings of the review. new protocol • Unclear if there Even where the developed by would be change new studies the DGAC in ROB ratings, observe results to determine but if there consistent with relevance were significant the existing data, using criteria differences it could increasing the included in the impact systematic number of stud- methodology review outcomes ies can improve manual if the they are precision of effect • Considerations deciding between estimates, dem- for when and how two grades onstrate wider to use existing applicability of systematic the effect, or en- reviews are able additional available, but not comparisons or at the level of subgroup analyses decision guides or to be performed.
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would be considered an update of a systematic review • Risk of bias assessment was not re accomplished when existing systematic reviews were used and documentation was not presented that showed that the older tool would detect risk of bias the same as the newer tool adopted • The 2020 methodology manual stated, "In addition, the complete systematic review update was documented, including details about the protocol and methodology, the full description and synthesis of the evidence, and conclusion statements and grades" continued
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the re- and suggested view in response proposed edits to to reviewer com- the appropriate ments subcommittee and sent responses back to peer reviewers • External peer review of full systematic review protocol was not completed prior to conducting the systematic review
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2020. Assessment of publication bias and outcome reporting bias in systematic reviews of health services and delivery research: A metaepidemiological study.
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USPSTF (U.S. Preventive Services Task Force)
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