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Scope

Key Words
Evidence Based Practice; Trustworthy Clinical Guidelines; Network Meta analysis (NMA); GRADE; Rare Diseases; Chronic Diseases; Aging; Alternative Medicine
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Research Interests

  1. Health research methods on clinical guideline development, evidence synthesis (effectiveness on multiple interventions), and cohort studies

  2. Incorporating AI technology in living guideline development and evidence synthesis

  3. Health research on rare diseases and chronic diseases (e.g., insomnia, chronic pain)

  4. Alternative medicine (TCM, acupuncture, et al)

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Projects

  1. Rapid recommendations for chronic Insomnia, PTSD, Chronic Fatigue, fibromyalgia

  2. Loops consideration for indirect evidence in NMA

  3. Holiday effect for hospital admission and surgery

  4. AI-assisted evidence synthesis and living guidelines

Research Vision

Vision

Vision

Our Team, the AdvanCing Health through Intelligent Evidence and liVing guidelines Enhancement (ACHIEVE), is a research group dedicated to advancing health through intelligent evidence and living guidelines enhancement. Our research aims to bridge the gap between clinical evidence and practice, enhancing patient outcomes and quality of life through reliable evidence synthesis and trustworthy guideline development.​​

 

We are passionate about advancing health through intelligent evidence and living guidelines enhancement. Our team is committed to conducting high-quality research on clinical guideline development and living evidence synthesis. We aim to make a significant impact in the field of healthcare by providing valuable insights and contributing to evidence-based practices. ACHIEVE stands out for its dedication to excellence and innovation, and we are always looking for opportunities to collaborate with like-minded individuals and organizations.

Selected Publications

1. Evidence vs Consensus Guidelines

This study investigated whether the alignment of strength of recommendations with quality of evidence differs in consensus-based versus evidence-based guidelines. The study included 12 ACC/AHA guidelines that generated 1,434 recommendations and 69 ASCO guidelines that generated 1,094 recommendations. ​

The findings suggest consensus-based guidelines produce more recommendations violating the principles of evidence-based medicine than evidence-based guidelines. Ensuring the appropriate alignment of quality of evidence with the strength of recommendations is key to the development of “trustworthy” guidelines. This work, for the first time, highlighted the importance of assessing the appropriateness of strong recommendations and provided guidance on how to address it.

Yao L, Ahmed MM, Guyatt GH, Yan P, Hui X, Wang Q, Yang K, Tian J, Djulbegovic B. Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis. BMJ. 2021 Nov 25;375:e066045. doi: 10.1136/bmj-2021-066045. PMID: 34824101; PMCID: PMC8613613.​​

2. Inappropriate Strong Recommendations

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Some organizations—including the ACC/AHA and ASCO—explicitly classify their guidelines as evidence-based when much of the supporting evidence is deemed to be moderate or high quality, and classify their guidelines as consensus based when it is not.

Our findings suggest when facing low or very low-quality evidence, guidelines should avoid issuing inappropriate discordant recommendations. Abandoning consensus-based guidelines is likely to facilitate this goal.

Yao L, Guyatt GH, Djulbegovic B. Can we trust strong recommendations based on low quality evidence? BMJ. 2021 Nov 25;375:n2833. doi: 10.1136/bmj.n2833. PMID: 34824089; PMCID: PMC8769229.

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3. Management of Chronic TMD Pain

To support the guideline development for chronic pain secondary to Temporomandibular Disorders (TMD), I led a team and conducted a complex network meta-analysis with a huge amount of work, involving over 200 RCTs and comparing 59 pharm and non-pharm treatments the same time (see the right figure).

In this network, we were able to propose innovative methodologies including ranking the interventions by considering both statistics and certainty of evidence, considering the MID for interpretation, and calculating the possibility of achieving MID for measuring the outcomes. We finally identified 8 interventions proving effective for patients with TMD chronic pain. Our findings from the network meta-analysis informed 21 recommendations by the guideline panel. This work has become a trusted reference point for decision-makers in TMD

Yao L, Sadeghirad B, Li M, Li J, Wang Q, Crandon HN, Martin G, Morgan R, Florez ID, Hunskaar BS, Wells J, Moradi S, Zhu Y, Ahmed MM, Gao Y, Cao L, Yang K, Tian J, Li J, Zhong L, Couban RJ, Guyatt GH, Agoritsas T, Busse JW. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023 Dec 15;383:e076226. doi: 10.1136/bmj-2023-076226. Erratum in: BMJ. 2024 Jan 30;384:q253. doi: 10.1136/bmj.q253. PMID: 38101924.​

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