Background: Essential medicines are those that satisfy a population’s priority healthcare needs, and are selected by considering disease prevalence, evidence on efficacy, safety and comparative cost-effectiveness. The National Nutrition Directorate (NND) asked the Centre for Evidence-based Health Care at Stellenbosch University to review and summarise the evidence on parenteral glutamine supplementation in critically ill adults, for their submission to the National Tertiary and Quaternary Level EML Expert Review Committee on the inclusion of parenteral glutamine in the South African EML.
Objective: To describe our approach to reviewing and preparing a summary of the best-available evidence to inform the EML Expert Review Committee’s decision making
Methods: In consultation with the NND, we formulated an answerable question that defined our eligibility criteria. Search yields from six electronic databases (December 2015) were screened independently and in duplicate to find all eligible systematic reviews (SRs). We assessed methodological quality (validated AMSTAR tool) and extracted outcome data from all included SRs. The most recent, comprehensive SR with the highest methodological quality was selected to form the basis the summary, which included an Evidence Profile. The risk of bias and certainty of the evidence in this review was determined using the ROBIS tool and GRADE.
Results: The findings of 12 SRs were included in the summary. Using the selected SR, we prepared an Evidence Profile providing the effect size and certainty of the evidence for seven important outcomes in critically ill patients supplemented with parenteral glutamine only. For context and comparison, we tabulated summary estimates for the seven outcomes from all included SRs and for various subgroups of patients (e.g. elective major surgery, acute pancreatitis). We submitted the summary and presented it at an EML Committee meeting.
Conclusions: Using a systematic, transparent approach to access, critically appraise, summarise and present the best available evidence, we contributed to facilitating the use of research evidence in national policy decision making.