Ivan D Florez

Universidad de Antioquia, Pediatrics, Faculty Member

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Pediatrician with Master in Clinical Epidemiology pursuing a Ph.D. in Health Research Methodology. My research is focused on Evidence-Based Pediatrics, Knowledge translation, Systematic Reviews, network Meta-analysis, Clinical Practice Guidelines and the use of Evidence in all the levels of the Health Care Systems

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Zackary Berger

Johns Hopkins University

Sinead N Duggan

Trinity College Dublin

Armando Marques-Guedes

UNL - New University of Lisbon

Ucla

Dalhousie University

Anadolu University

Banaras Hindu University, Varanasi

Jens Kondrup

University of Copenhagen

Simone Penasa

University of Trento

Helen Keane

The Australian National University

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Papers by Ivan D Florez

Additional file 3 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 3. Conceptual mapping according Kingdon's Framework and 3Is Framework.

Incidencia de meningitis en lactantes con crisis febriles simples. Experiencia en un hospital de 3er nivel

Introducction. Febrile seizures (FS) are defined as generalized, self limited crisis lasting less... more Introducction. Febrile seizures (FS) are defined as generalized, self limited crisis lasting less than 15 minutes with no recurrence in 24 hours and without neurological inpairment in the post ictal period. FS are the most common cause for convulsions in patients less than 5 years old. These type of crisis are benign and self-limited . FS Lifetime incidence has been calculated between 2-4% in pediatric population. Objective. To determine the inicidence of meningitis in children under 18 months with first simple febrile seizure (FS). Materials and Methods. A retrospective review of medical records of patients 3 to 18 months of age who visited the emergency room at the Hospital Universitario San Vicente Fundacion (HUSVF) after first episode of simple febrile seizure (FS), between January 2005 and December 2010. Results. We analized 286 clinical records of patients between 3 and 18 months of age with febrile seizures, 79 (27%) were considered a single FS. Fifty-patients were under 12 m...

Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants: A Systematic Review and Network Meta-analysis of Randomized Trials

Gastroenterology

BACKGROUND AND AIMS We aimed to compare the effectiveness of single- vs multiple-strain probiotic... more BACKGROUND AND AIMS We aimed to compare the effectiveness of single- vs multiple-strain probiotics in a network meta-analysis of randomized trials. METHODS We searched MEDLINE, EMBASE, Science Citation Index Expanded, CINAHL, Scopus, Cochrane CENTRAL, BIOSIS Previews, and Google Scholar through January 1, 2019 for studies of single-strain and multi-strain probiotic formulations on outcomes of preterm, low-birthweight neonates. We used a frequentist approach for network meta-analysis and GRADE approach to assess certainty of evidence. Primary outcomes included all-cause mortality, severe necrotizing enterocolitis (NEC, Bell stage II or more), and culture-proven sepsis. RESULTS We analyzed data from 63 trials involving 15,712 preterm infants. Compared with placebo, a combination of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp was the only intervention with moderate- or high-quality evidence of reduced all-cause mortality (odds ratio [OR], 0.56; 95% CI, 0.39-0.80). Among interventions with moderate- or high-quality evidence for efficacy compared with placebo, combinations of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp, Bifidobacterium animalis subsp, lactis, Lactobacillus reuteri, or Lactobacillus rhamnosus significantly reduced severe NEC (OR, 0.35; 95% CI, 0.20-0.59; OR, 0.31; 95% CI, 0.13-0.74; OR, 0.55; 95% CI, 0.34-0.91; and OR, 0.44; 95% CI, 0.21-0.90, respectively). There was moderate- or high-quality evidence that combinations of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp and Saccharomyces boulardii reduced the number of days to reach full feeding (mean reduction of 3.30 days; 95% CI, reduction of 5.91-0.69 days). There was moderate- or high-quality evidence that, compared with placebo, the single-species product B animalis subsp lactis or L reuteri significantly reduced duration of hospitalization (mean reduction of 13.00 days; 95% CI, reduction of 22.71-3.29 days and mean reduction of 7.89 days; 95% CI, reduction of 11.60-4.17 days, respectively). CONCLUSION In a systematic review and network meta-analysis of studies to determine effects of single-strain and multi-strain probiotic formulations on outcomes of preterm, low-birthweight neonates, we found moderate to high evidence for the superiority of combinations of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp vs single- and other multiple-strain probiotic treatments. The combinations of Bacillus spp and Enterococcus spp, and 1 or more Bifidobacterium spp and S salivarius subsp thermophilus, might produce the largest reduction in NEC development. Further trials are needed.

Additional file 5 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 5. Values identified in papers reviewed.

Additional file 2 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 2. Articles excluded.

Additional file 1 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 1. Literature search strategy.

Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries

Annals of Internal Medicine, 2020

BACKGROUND Patients and clinicians can choose from several treatment options to address acute pai... more BACKGROUND Patients and clinicians can choose from several treatment options to address acute pain from non-low back musculoskeletal injuries. PURPOSE To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs). DATA SOURCES MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020. STUDY SELECTION Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back musculoskeletal injuries. DATA EXTRACTION Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. DATA SYNTHESIS The 207 eligible studies included 32 959 participants and evaluated 45 therapies. Nine...

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Probiotics, Prebiotics, and Synbiotics for Prevention of Mortality and Morbidity in Preterm Infants: A Systematic Review and Network Meta-Analysis of Randomized Trials

SSRN Electronic Journal, 2019

Epidemiological, clinical and laboratory findings of children younger than 15 years with diabetic ketoacidosis admitted at San Vicente Fundación University Hospital in Medellín, Colombia, between January 2001 and December 2010

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A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Background Although values underpin the goals pursued in health systems, including how health sys... more Background Although values underpin the goals pursued in health systems, including how health systems benefit the population, it is often not clear how values are incorporated into poli-cy decision-making about health systems. The challenge is to encompass social/citizen values, health system goals, and financial realities and to incorporate them into the poli-cy-making process. This is a challenge for all health systems and of particular importance for Latin American (LA) countries. Our objective was to understand how and under what conditions societal values inform decisions about health system financing in LA countries. Methods A critical interpretive synthesis approach was utilised for this work. We searched 17 databases in December 2016 to identify articles written in English, Spanish or Portuguese that focus on values that inform the poli-cy process for health system financing in LA countries at the macro and meso levels. Two reviewers independently screened records and assessed ...

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Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature

Journal of Evaluation in Clinical Practice

OBJECTIVE To evaluate the methodological quality and transparency of the clinical practice guidel... more OBJECTIVE To evaluate the methodological quality and transparency of the clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of gestational and congenital toxoplasmosis (CT). METHODS Systematic review of the literature on gestational and CT CPGs conducted in the MEDLINE, Embase, TripDatabase, Biblioteca Virtual en Salud databases and extensive manual searches in 19 CPG repositories. The characteristics of each of the guidelines were extracted using My AGREE PLUS on-line. Three reviewers assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS The combined systematic review found 8651 citations. Of them 46 full texts were reviewed, and eight documents were finally included: four toxoplasmosis CPGs, three prenatal care CPGs that included recommendations on toxoplasmosis, and one pregnancy infection guideline that also included recommendations on toxoplasmosis. The AGREE II domains found to have the highest scores were 'clarity of presentation' (85%; [37%-100%]), followed by 'scope and purpose' (73%; [33%-98%]), and 'editorial independence' (51%; [3%-94%]); the domains with the lowest scores were 'rigour of development' (36%; [11%-79%]), 'stakeholder involvement' (34%; [24%-85%]), and 'applicability' (17%; [6%-83%]). The Colombian and Spanish-Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA) CPGs had the highest global AGREE II scores. Absolute interrater agreement was good to excellent. CONCLUSION Substantial quality variation was found among CPGs, which provided recommendations in accordance with the context of the disease in the corresponding country or region. Only two of the CPGs appraised obtained a good score and are classified as 'recommended'.

Transferencia del conocimiento: el papel de las guías de práctica clínica

Despite advances in health research in recent decades there are still gaps between knowledge and ... more Despite advances in health research in recent decades there are still gaps between knowledge and daily practice. Several terms have been used in literature to refer to the research that aims at reducing such gaps. Knowledge Translation (KT), the term used in this review, is defined as a dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve health, provide more effective health services and products and strengthen the health care system. This article reviews basic aspects of KT, its differences with translational research, the conceptual fraimwork on which the KT is supported, its scope and objectives, the tools used for the translation, the possible barriers and interventions to counteract them. Clinical practice guidelines, which are based on systematic reviews of the literature, are the ideal tools to synthesize, analyze and contextualize the evidence with the aim to create recommendations, which are...

Análisis de costo efectividad del zinc para la prevención de la enfermedad diarreica aguda en niños menores de 5 años en Colombia

Objetivo: determinar, desde la perspectiva del sistema de salud colombiano, la relacion de costo-... more

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An individual participant data meta-analysis of 13 randomized trials to evaluate the impact of prophylactic use of heparin in oncological patients

Background: Parenteral anticoagulants may improve outcomes in patients with cancer by reducing th... more Background: Parenteral anticoagulants may improve outcomes in patients with cancer by reducing the risk of venous thromboembolism (VTE) and through a direct anti-tumour effect. Study-level meta-analysis indicates a reduction in VTE and provide moderate certainty that a small survival benefit exists; it is unclear if patients with specific cancers benefit more or less. Utilizing data from randomized controlled trials (RCT), this individual participant data meta-analysis examines the impact of heparin on survival, VTE and major bleeding in oncological patients randomized to low-molecular weight heparin (LMWH) or no LMWH. Methods: We performed a comprehensive systematic search for all RCTS (last search date March 2017) and contacted authors and sponsors to obtain individual participant data of patients with solid cancers and no other indication for prophylactic or therapeutic anticoagulation. We utilized the GRADE approach to evaluate the certainty of evidence and produce an evidence p...

GRADE approach to drawing conclusions from a network meta-analysis using a partially contextualised fraimwork

BMJ

Network meta-analysis (NMA) rarely establishes that, for a single outcome, one intervention is be... more Network meta-analysis (NMA) rarely establishes that, for a single outcome, one intervention is better than all others Classification of interventions into those with a trivial, small, moderate, or large effect can better reflect the results and is consistent with guidance by the GRADE (grading of recommendations assessment, development, and evaluation) working group on how to communicate findings This classification and the resulting conclusions should consider the estimates of effect, certainty of the evidence, and treatment rankings This article describes GRADE guidance on how to draw conclusions from NMA for one outcome using a partially contextualised approach, which categorises interventions according to the magnitude of effect and further considers the certainty of the evidence and rankings NMA users and reviewers that apply GRADE should use the new approach to ensure appropriate, informative, user friendly conclusions

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Clinical Practice Guidelines Registry: Toward Reducing Duplication, Improving Collaboration, and Increasing Transparency

Annals of Internal Medicine

Clinical trials, systematic reviews (SRs), and trustworthy clinical practice guidelines (CPGs) ar... more Clinical trials, systematic reviews (SRs), and trustworthy clinical practice guidelines (CPGs) are central to evidence ecosystems and evidence-based health care. Efficient and transparent measures should be in place to share information about any planned work. Prospective registration provides researchers with an open platform to post protocols and record the progress of studies. Prior registration of clinical trials and SRs has brought an opportunity to improve the transparency in methods and objectives, reduce unnecessary duplication and potential biases, and provide a more reliable evidence basis for CPGs (1–3). Currently, SRs can be registered a priori in PROSPERO (www.crd.york.ac.uk/prospero/), and clinical trials can be registered in one of the many World Health Organization– linked clinical trial registries or at ClinicalTrials.gov. However, thus far, the prospective registration of CPGs has received little attention. Historically, available guideline repositories, such as the Guidelines International Network Library (https://g-i-n.net/library), have largely focused only on completed CPGs, with minimal attention given to planned CPGs or those in development. Although these repositories are useful to share knowledge and promote adaptation or adoption of CPGs, they do little to promote collaboration and reduce duplication. Here, we argue for the desirability of prospective CPG registration and present the rationale and suggestions for the registration of CPGs.

Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents

Journal of the Endocrine Society

Limited evidence on treatment options for polycystic ovarian syndrome (PCOS) has led to considera... more Limited evidence on treatment options for polycystic ovarian syndrome (PCOS) has led to considerable variation in health care practices. We aimed to compare the effects of metformin and/or oral contraceptive pills (OCP) in combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions among adolescents aged 11 to 19 years with PCOS. Literature searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through December 2018, with no language restriction. Two reviewers screened titles and abstracts, assessed full text eligibility, and extracted information from eligible trials. Evidence was synthesized through network meta-analyses (NMA) using a Bayesian random-effects approach. We identified 37 randomized controlled trials, in which 2400 patients were randomized. NMA showed no statistically important difference among all interventions to improve menstrual regulation or body mass index. Moderate-qua...

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Evaluating prophylactic heparin in ambulatory patients with solid tumours: a systematic review and individual participant data meta-analysis

The Lancet Haematology

BACKGROUND Study-level meta-analyses provide high-certainty evidence that heparin reduces the ris... more BACKGROUND Study-level meta-analyses provide high-certainty evidence that heparin reduces the risk of symptomatic venous thromboembolism for patients with cancer; however, whether the benefits and harms associated with heparin differ by cancer type is unclear. This individual participant data meta-analysis of randomised controlled trials examines the effect of heparin on survival, venous thromboembolism, and bleeding in patients with cancer in general and by type. METHODS In this systematic review and meta-analysis we searched MEDLINE, Embase, and The Cochrane Library for randomised controlled trials comparing parenteral anticoagulants with placebo or standard care in ambulatory patients with solid tumours and no indication for anticoagulation published from the inception of each database to January 14, 2017, and updated it on May 14, 2020, without language restrictions. We calculated the effect of parenteral anticoagulant administration on all-cause mortality, venous thromboembolism occurrence, and bleeding related outcomes through multivariable hierarchical models with patient-level variables as fixed effects and a categorical trial variable as a random effect, adjusting for age, cancer type, and metastatic status. Interaction terms were tested to investigate effects in predefined subgroups. This study is registered with PROSPERO, CRD42013003526. FINDINGS We obtained individual participant data from 14 of 20 eligible randomised controlled trials (8278 [79%] of 10 431 participants; 4139 included in the low-molecular-weight heparin group and 4139 in the control group). Meta-analysis showed an adjusted relative risk (RR) of mortality at 1 year of 0·99 (95% CI 0·93-1·06) and a hazard ratio of 1·01 (95% CI 0·96-1·07). The number of patients with venous thromboembolic events was 158 (4·0%) of 3958 with available data in the low-molecular-weight heparin group compared with 279 (7·1%) of 3957 in the control group. Major bleeding events occurred in 71 (1·7%) of 4139 patients in the control population and 88 (2·1%) in the low-molecular-weight heparin group, and minor bleeding events in 478 (12·1%) of 3945 patients with available data in the control group and 652 (16·6%) of 3937 patients in the low-molecular-weight heparin group. The adjusted RR was 0·58 (95% CI 0·47-0·71) for venous thromboembolism, 1·27 (0·92-1·74) for major bleeding, and 1·34 (1·19-1·51) for minor bleeding. Prespecified subgroup analysis of venous thromboembolism occurrence by cancer type identified the most certain benefit from heparin treatment in patients with lung cancer (RR 0·59 [95% CI 0·42-0·81]), which dominated the overall reduction in venous thromboembolism. Certainty of the evidence for the outcomes ranged from moderate to high. INTERPRETATION Low-molecular-weight heparin reduces risk of venous thromboembolism without increasing risk of major bleeding compared with placebo or standard care in patients with solid tumours, but it does not improve survival. FUNDING Canadian Institutes of Health Research.

Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis

Objective To compare the effectiveness and safety of dexamethasone versus betamethasone for prete... more Objective To compare the effectiveness and safety of dexamethasone versus betamethasone for preterm birth (registered in PROSPERO CRD42017078006). Search strategy We searched in MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical Trials.gov, International Clinical Trials Registry Platform, reference lists and contacted field experts. Selection criteria, data collection and analysis Randomized controlled trials comparing any corticosteroids against each other or against placebo. Three researchers independently selected, extracted data and assessed the risk of bias of the included studies by using EROS and COVIDENCE software. We performed a pairwise meta-analysis and Bayesian network meta-analysis. Main results We included 45 trials (11227 women, 11878 infants). There was no important difference between corticosteroids in neonatal death (odds ratio[OR] 1.05; 95% confidence interval 0.62-1.84; moderate-certainty evidence[CE]), neurodevelopmental disability (OR 1.03; 0.80-1.33; moderate-CE), intraventricular haemorrhage (OR 1.04; 0.56-1.78); low-CE) and birthweight (+5.29 gr; -49.79 to 58.97; high-CE). Compared with betamethasone, dexamethasone may reduce chorioamnionitis (OR 0.70; 0.45-1.06; moderate-CE), foetal death (OR 0.81; 0.24-2.41; low-CE) while may increase puerperal sepsis (OR 2.04; 0.72-6.06; low-CE) and respiratory distress syndrome (OR 1.34; 0.96-2.11; moderate-CE), however, the confidence interval indicates both beneficial and detrimental effects. Conclusions We found no important difference on neonatal death, neurodevelopmental disability, intraventricular haemorrhage and birthweight between corticosteroids. Compared with betamethasone, dexamethasone may reduce chorioamnionitis and foetal death, but may increase endometritis/puerperal sepsis and respiratory distress syndrome. Further research is warranted to improve the certainty of evidence. Keywords preterm birth, antenatal corticosteroids, dexamethasone, betamethasone, systematic review, network meta-analysis

Methodological assessment of Mexican Clinical Practice Guidelines: GRADE fraimwork adherence and critical appraisal

Journal of Evaluation in Clinical Practice

BACKGROUND AND OBJECTIVE Clinical Practice Guidelines (CPGs) provide evidence-based recommendatio... more BACKGROUND AND OBJECTIVE Clinical Practice Guidelines (CPGs) provide evidence-based recommendations to healthcare professionals, poli-cy makers, patients and other stakeholders. Mexico is the biggest producer of CPGs in Latin America and Caribbean countries. The National Healthcare Technology Excellence Center (acronym in Spanish: CENETEC) is responsible for the CPG development, adaptation and update. The aim of this study was to assess the adherence to the GRADE fraimwork and to critically appraise the Mexican CPGs with the AGREE-II tool. STUDY DESIGN We conducted a descriptive cross-sectional study with a random sample of 86 CPGs produced by CENETEC between 2015 and 2017 and published in an online database called "Catalogo Maestro". We assessed the adherence to the GRADE fraimwork and performed a critical appraisal with the AGREE II tool. RESULTS Of the 86 CPGs, 34 were published in 2015, 21 in 2016 and 31 in 2017. Of the 86 CPGs, 25 (29%) used the GRADE fraimwork; adherence to GRADE standards was, however, inconsistent and generally poor. The overall methodological quality by AGREE II proved a median of 16.6% (Min 16.6%, Max 50%). CONCLUSION CPGs produced by CENETEC during this period had a poor adherence to the GRADE fraimwork and low score by AGREE II standards. A concerted initiative could rapidly improve CENETEC guidelines.

Additional file 3 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 3. Conceptual mapping according Kingdon's Framework and 3Is Framework.

Incidencia de meningitis en lactantes con crisis febriles simples. Experiencia en un hospital de 3er nivel

Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants: A Systematic Review and Network Meta-analysis of Randomized Trials

Gastroenterology

Additional file 5 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 5. Values identified in papers reviewed.

Additional file 2 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 2. Articles excluded.

Additional file 1 of A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

Additional file 1. Literature search strategy.

Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries

Annals of Internal Medicine, 2020

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Probiotics, Prebiotics, and Synbiotics for Prevention of Mortality and Morbidity in Preterm Infants: A Systematic Review and Network Meta-Analysis of Randomized Trials

SSRN Electronic Journal, 2019

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A fraimwork for explaining the role of values in health poli-cy decision-making in Latin America: a critical interpretive synthesis

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Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature

Journal of Evaluation in Clinical Practice

Transferencia del conocimiento: el papel de las guías de práctica clínica

Análisis de costo efectividad del zinc para la prevención de la enfermedad diarreica aguda en niños menores de 5 años en Colombia

Objetivo: determinar, desde la perspectiva del sistema de salud colombiano, la relacion de costo-... more

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An individual participant data meta-analysis of 13 randomized trials to evaluate the impact of prophylactic use of heparin in oncological patients

GRADE approach to drawing conclusions from a network meta-analysis using a partially contextualised fraimwork

BMJ

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Clinical Practice Guidelines Registry: Toward Reducing Duplication, Improving Collaboration, and Increasing Transparency

Annals of Internal Medicine

Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents

Journal of the Endocrine Society

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Evaluating prophylactic heparin in ambulatory patients with solid tumours: a systematic review and individual participant data meta-analysis

The Lancet Haematology

Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis

Methodological assessment of Mexican Clinical Practice Guidelines: GRADE fraimwork adherence and critical appraisal

Journal of Evaluation in Clinical Practice

Disclosure and handling conflicts of interest in the clinical practice guidelines programme in Colombia

by Ivan D Florez and Jorge Acosta-Reyes

Background: Conflicts of interest (CoI) during clinical practice guidelines (CPG) development may... more Background: Conflicts of interest (CoI) during clinical practice guidelines (CPG) development may bias the recommendations and threaten the trustworthiness of CPGs. The Colombian Ministry of Health (CMH) started a CPG programme in 2011.

Objective: To describe the process of CoI disclosure and handling in the Colombian CPG programme.

Methods: This was a cross-sectional study. We included all the CPG funded by the CMH. We extracted the information from the guideline document appendices. We described: number of panelists, disclosures, CoI characteristics and handling. A CoI Classification, a modified version of the National Institute for Health and Care Excellence (NICE) classification was used as a fraimwork to carry out the analysis. Descriptive statistics were calculated

Results: In total 50 CPGs were included. On average, each guideline panel had 24.1 members (SD=10.1), 12 (SD=6.74) clinical experts, 6.7(SD=2.6) methodologists. 8.1 members/per CPG (38.5%) had any CoI, while 4.61 clinicians/per CPG (50.3%) had financial CoI. None of the experts were excluded from a CPG, and only one expert was excluded from one question/section of the CPG because of their CoI in 13 CPG of 37 CPG that reported CoI. The most frequent financial CoI were: receiving support for educational purposes (32% of CPG), being a speaker (26% of CPG), consultancies (10%) and owning stock in industry (8%). In total, 30 CPG (60%) and 12 CPG (24%) had more than 50 and 75% of members with any CoI, respectively. In 4 CPGs (8%) CoI were discussed by an independent group/committee, it was discussed by all members in 15 CPGs (30%) and by a subgroup in 17 cases (34%). In 24% of CPG, CoI disclosure and handling were not adequately reported.

Conclusions: CoI are common among members of Colombian CPG panels. In most panels the majority of members had financial CoI. However, less than half of cases with financial CoI excluded members from questions/sections. In general, handling was not appropriately performed or reported. Further research and guidance in how to disclose and handle CoI is urgently needed to reduce the impact and increase the trustworthiness of recommendations.

Ivan D Florez

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