Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidel...Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.展开更多
Objective： To systematically review the clinical practice guidelines （CPGs） for ischemic stroke in Chinese medicine （CM） with the Appraisal of Guidelines for Research and Evaluation （AGREE II） instrument. Meth...Objective： To systematically review the clinical practice guidelines （CPGs） for ischemic stroke in Chinese medicine （CM） with the Appraisal of Guidelines for Research and Evaluation （AGREE II） instrument. Methods： CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPG- related handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based （EB） guideline, consensus based with no explicit consideration of evidence based （CB-EB） guideline and consensus based （CB） guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE II instrument, and compared the CPGs＇ recommendations on CM pattern classification and treatment. Results： Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. Conclusion： The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.展开更多
目的评价中药灌肠治疗溃疡性结肠炎(ulcerative colitis,UC)临床实践指南(clinical practice guidelines,CPGs)和专家共识的质量,并对推荐的中药灌肠方案进行内容一致性分析。方法检索主要中英文数据库和医脉通、SIGN、NICE、WHO等指南...目的评价中药灌肠治疗溃疡性结肠炎(ulcerative colitis,UC)临床实践指南(clinical practice guidelines,CPGs)和专家共识的质量,并对推荐的中药灌肠方案进行内容一致性分析。方法检索主要中英文数据库和医脉通、SIGN、NICE、WHO等指南网站及数据库,检索时限为建库至2023年11月1日。汇总分析中药灌肠相关推荐内容,并采用AGREE-China、RIGHT和JBI工具分别评价CPGs和专家共识的质量。结果最终纳入2部CPGs和5部专家共识。内容分析结果表明:各CPGs和专家共识中中药灌肠推荐意见存在不一致,未详细报告证据等级和推荐强度。结肠宁、锡类散和康复新液以及血竭、复方黄柏、青黛、乌梅和三七等是不同CPGs和共识中推荐频率相对较高的方剂和中药。AGREE-China 5个领域的总得分(报告率)分别为:(62.86±29.82)分、(76.07±23.29)分、(30.00±31.74)分、(85.24±17.53)分和(14.29±34.99)分。其中,4篇强推荐、2篇弱推荐和1篇不推荐。RIGHT评价结果显示:CPGs报告项目占45.71%、未报告占44.29%、部分报告(不适用)占10.00%。JBI评价结果显示:专家共识整体质量较高。结论我国中药灌肠治疗UC相关CPGs和共识整体方法学质量有待进一步加强,不同CPG和共识中药灌肠治疗UC相关推荐内容不全面且证据基础不足。期待后期国内研究者整合现有CPG和共识证据,制定全面规范的本土化中药灌肠治疗UC的循证指南,提高适用性,正确指导临床和护理合理选择灌肠中药,发挥中药灌肠疗护UC的特色优势。展开更多
Objective： To assess the quality of integrative medicine clinical practice guidelines（CPGs） published before 2014. Methods： A systematic search of the scientific literature published before 2014 was conducted to s...Objective： To assess the quality of integrative medicine clinical practice guidelines（CPGs） published before 2014. Methods： A systematic search of the scientific literature published before 2014 was conducted to select integrative medicine CPGs. Four major Chinese integrated databases and one guideline database were searched： the Chinese Biomedical Literature Database（CBM）, the China National Knowledge Infrastructure（CNKI）, China Science and Technology Journal Database（VIP）, Wanfang Data, and the China Guideline Clearinghouse（CGC）. Four reviewers independently assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation（AGREE） Ⅱ Instrument. Overall consensus among the reviewers was assessed using the intra-class correlation coefficient（ICC）. Results： A total of 41 guidelines published from 2003 to 2014 were included. The overall consensus among the reviewers was good [ICC： 0.928; 95% confidence interval（CI）： 0.920 to 0.935]. The scores on the 6 AGREE domains were： 17% for scope and purpose（range： 6% to 32%）, 11% for stakeholder involvement（range： 0 to 24%）, 10% for rigor of development（range： 3% to 22%）, 39% for clarity and presentation（range： 25% to 64%）, 11% for applicability（range： 4% to 24%）, and 1% for editorial independence（range： 0 to 15%）. Conclusions： The quality of integrative medicine CPGs was low, the development of integrative medicine CPGs should be guided by systematic methodology. More emphasis should be placed on multi-disciplinary guideline development groups, quality of evidence, management of funding and conflicts of interest, and guideline updates in the process of developing integrative medicine CPGs in China.展开更多
Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney transplantation.The American Heart Association a...Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney transplantation.The American Heart Association and American College of Cardiology joint statement provides guidance on risk stratification for the major cause of heart failure for these patients in its recommendations for coronary heart disease.Herein we provide an overview of the available literature on risk strati-fication for nonischemic heart failure and functional heart disease states such as pulmonary hypertension.Many of these options for optimizing these patients be-fore transplant include optimizing their volume status,often with more agg-ressive ultrafiltration.Kidney transplantation remains the treatment of choice for patients with advanced kidney disease and cardiac disease,the correction of the azotemic substances with kidney transplantation has been associated with imp-roved survival than remaining on dialysis long-term.The findings in the studies reviewed here are expected to help clinicians refine current strategies for evalua-ting potential kidney transplant recipients.展开更多
目的:对预防结直肠癌术后肠梗阻临床实践指南进行质量评价及内容分析,为我国预防结直肠癌术后肠梗阻的实践提供参考。方法:检索苏格兰院际指南网、国际指南协作网、新西兰指南工作组等指南网站,检索促进术后恢复学会、美国结肠和直肠外...目的:对预防结直肠癌术后肠梗阻临床实践指南进行质量评价及内容分析,为我国预防结直肠癌术后肠梗阻的实践提供参考。方法:检索苏格兰院际指南网、国际指南协作网、新西兰指南工作组等指南网站,检索促进术后恢复学会、美国结肠和直肠外科医师学会、美国胃肠病学会等肠梗阻相关网站,检索PubMed、Web of Science、中国知网、万方数据知识服务平台等数据库发布的结直肠癌术后肠梗阻相关指南,检索时限为2011年1月1日—2021年12月1日。由2名研究者独立对文献进行筛选和资料提取,采用临床指南与评价系统Ⅱ(AGREEⅡ)对指南进行评价,汇总分析预防结直肠癌术后肠梗阻的推荐内容。结果:共纳入相关指南5篇,纳入指南的总体质量评价为2篇A级、3篇B级。AGREEⅡ中6个领域平均标准化得分分别为范围和目的85.55%、参与人员67.78%、严谨性70.00%、清晰性86.67%、应用性53.33%、独立性78.33%。通过内容分析,最终出两大主题、29条推荐意见。结论:纳入的5篇指南总体质量一般,评价分析后得到的预防结直肠癌术后肠梗阻的部分推荐意见内容宽泛,需要不同程度的完善。展开更多
目的甄选高质量早泄诊治医患沟通指南,促进医患之间更加有效和富有同理心的沟通,并为后续制定高质量指南提供参考。方法计算机检索中英文数据库,补充医脉通、用药助手、丁香园等网站的指南,使用临床实践指南研究与评价系统Ⅱ(appraisal ...目的甄选高质量早泄诊治医患沟通指南,促进医患之间更加有效和富有同理心的沟通,并为后续制定高质量指南提供参考。方法计算机检索中英文数据库,补充医脉通、用药助手、丁香园等网站的指南,使用临床实践指南研究与评价系统Ⅱ(appraisal of guidelines,research and evaluation,AGREEⅡ)和医疗保健实践指南的报告项目(reporting items for practice guidelines in heal thcare,RIGHT)检查表来评估符合条件的临床实践指南的方法和报告质量,计算评审者对组内相关系数(intra-class correlation coefficient,ICC)的总体一致性。结果共纳入3份指南,每个领域评审人员的总体一致性是可以接受的。AGREEⅡ评价结果显示,3篇指南推荐级别均为B级,3篇指南6个领域的平均报告率为44.07%,其中领域一最高(92.59%),领域六最低(16.67%)。RIGHT评价结果显示,指南平均报告率为24.08%。结论早泄诊治医患沟通指南质量有待提高,指南制订者应严格按照AGREEⅡ和RIGHT的要求规范撰写,重视对患者的情感关怀,以期提高临床早泄的诊治效率,并为后续制定高水平指南提供参考。展开更多
Cholangiocarcinoma(CC)is the second most common primary liver tumour.High-quality guidelines are essential for effective patient stratification and individualised treatment.This study aimed to appraise the methodologi...Cholangiocarcinoma(CC)is the second most common primary liver tumour.High-quality guidelines are essential for effective patient stratification and individualised treatment.This study aimed to appraise the methodological quality of existing guidelines for the resection of CC using the Appraisal of Guidelines for Research&Evaluation(AGREE II)instrument.A systematic search of the literature in Cochrane,PubMed,Google Scholar,and Embase was performed.Assessment of the clinical practice guidelines(CPGs)and consensuses was performed using the AGREE II instrument by four clinicians experienced in surgical practice and the AGREE II appraisal method.Literature searches identified 13 guidelines of highly variable quality according to the AGREE II criteria.The guidelines scored well in certain domains such as scope&purpose(median score across all guidelines;65%),clarity of presentation(76%),and editorial independence(56%).However,they scored poorly for applicability(13%),rigour of development(30%),and stakeholder involvement(39%).None of the 13 guidelines was recommended universally for use without modification.Overall,the methodological quality of guidelines on the surgical management of CC is poor.Future updates should address and modify shortcomings detected by the AGREE II instrument,thereby facilitating better patient stratification and individualised treatment strategies.展开更多
目的使用指南研究与评价工具Ⅱ(AGREEⅡ)评价儿童青少年维生素D(VD)临床实践指南(VD指南),反映目前儿童青少年补充VD的基本共识和存在的争议。方法制定VD指南的纳入标准和检索策略,检索PubMed、Web of Science、中国期刊全文数据库、万...目的使用指南研究与评价工具Ⅱ(AGREEⅡ)评价儿童青少年维生素D(VD)临床实践指南(VD指南),反映目前儿童青少年补充VD的基本共识和存在的争议。方法制定VD指南的纳入标准和检索策略,检索PubMed、Web of Science、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库、美国国立指南文库(NGC)、指南国际网络(G-I-N)等相关指南数据库,按纳入标准纳入有关儿童青少年VD指南,提取和描述VD指南AGREEⅡ评价信息,使用AGREEⅡ评价纳入指南质量,使用组内相关系数(ICC)进行评价员间一致性检验。分析比较不同VD指南推荐内容的共识和差异。结果共纳入9篇VD指南,分别来自美国、中国、加拿大、法国、波兰和澳大利亚/新西兰。发表年度从2006至2012年。3篇为循证指南,其中2篇采用GRADE证据分级系统,1篇采用AHRQ证据分级系统;其余6篇为非循证指南。①指南质量经AGREEⅡ评分显示:6大领域的评分中,范围和目的、清晰性和应用性的总体平均得分均>50%,指南制定的参与人员、制定的严谨性和编辑的独立性有待加强(平均得分分别为48%、42%和28%);循证指南在指南的参与人员、制定的严谨性、编辑的独立性方面优于非循证指南。②总体归纳不同VD指南之间在推荐内容上有5个方面的主要差异。VD预防建议:各指南基本认同的是0～1岁婴儿400IU·d-1的VD缺乏预防量是安全的;VD治疗建议:美国(ES)指南推荐2000 IU·d-1(1～18岁),维持6周;阳光照射:美国和澳大利亚/新西兰的指南持不同推荐意见;VD2或VD3:不同指南推荐意见不同;25羟维生素D(25OHD)水平:各指南基本认同25OHD水平<30nmol·L-1时,佝偻病的患病率增加;孕妇及哺乳期妇女:各指南推荐这一人群要注意及时补充VD,或维持适宜的25OHD水平。结论①纳入VD指南整体质量仍有待提高。循证指南质量在指南的参与人员、制定的严谨性、编辑独立性方面优于非循证指南。②纳入VD指南推荐内容虽有一定的差异,但对于0～18岁人群400 IU·d-1的VD缺乏预防量被认为是安全的剂量。③中国VD指南推荐内容参考了国外高质量的指南,改编和制定国内高质量的指南迫在眉睫。展开更多
文摘Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.
基金Supported by the projects from the State Administration of Traditional Chinese Medicine(No.ZYYS-2011[0032]-2)the China Academy of Chinese Medical Sciences(No.Z0135,Z0260,and Z0221)the Hong Kong Hospital Authority
文摘Objective： To systematically review the clinical practice guidelines （CPGs） for ischemic stroke in Chinese medicine （CM） with the Appraisal of Guidelines for Research and Evaluation （AGREE II） instrument. Methods： CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPG- related handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based （EB） guideline, consensus based with no explicit consideration of evidence based （CB-EB） guideline and consensus based （CB） guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE II instrument, and compared the CPGs＇ recommendations on CM pattern classification and treatment. Results： Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. Conclusion： The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.
文摘目的评价中药灌肠治疗溃疡性结肠炎(ulcerative colitis,UC)临床实践指南(clinical practice guidelines,CPGs)和专家共识的质量,并对推荐的中药灌肠方案进行内容一致性分析。方法检索主要中英文数据库和医脉通、SIGN、NICE、WHO等指南网站及数据库,检索时限为建库至2023年11月1日。汇总分析中药灌肠相关推荐内容,并采用AGREE-China、RIGHT和JBI工具分别评价CPGs和专家共识的质量。结果最终纳入2部CPGs和5部专家共识。内容分析结果表明:各CPGs和专家共识中中药灌肠推荐意见存在不一致,未详细报告证据等级和推荐强度。结肠宁、锡类散和康复新液以及血竭、复方黄柏、青黛、乌梅和三七等是不同CPGs和共识中推荐频率相对较高的方剂和中药。AGREE-China 5个领域的总得分(报告率)分别为:(62.86±29.82)分、(76.07±23.29)分、(30.00±31.74)分、(85.24±17.53)分和(14.29±34.99)分。其中,4篇强推荐、2篇弱推荐和1篇不推荐。RIGHT评价结果显示:CPGs报告项目占45.71%、未报告占44.29%、部分报告(不适用)占10.00%。JBI评价结果显示:专家共识整体质量较高。结论我国中药灌肠治疗UC相关CPGs和共识整体方法学质量有待进一步加强,不同CPG和共识中药灌肠治疗UC相关推荐内容不全面且证据基础不足。期待后期国内研究者整合现有CPG和共识证据,制定全面规范的本土化中药灌肠治疗UC的循证指南,提高适用性,正确指导临床和护理合理选择灌肠中药,发挥中药灌肠疗护UC的特色优势。
基金Supported by the Special Program on Science and Technology of Traditional Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine and Guangdong Province Fund for Nature(No.S2013010015427)
文摘Objective： To assess the quality of integrative medicine clinical practice guidelines（CPGs） published before 2014. Methods： A systematic search of the scientific literature published before 2014 was conducted to select integrative medicine CPGs. Four major Chinese integrated databases and one guideline database were searched： the Chinese Biomedical Literature Database（CBM）, the China National Knowledge Infrastructure（CNKI）, China Science and Technology Journal Database（VIP）, Wanfang Data, and the China Guideline Clearinghouse（CGC）. Four reviewers independently assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation（AGREE） Ⅱ Instrument. Overall consensus among the reviewers was assessed using the intra-class correlation coefficient（ICC）. Results： A total of 41 guidelines published from 2003 to 2014 were included. The overall consensus among the reviewers was good [ICC： 0.928; 95% confidence interval（CI）： 0.920 to 0.935]. The scores on the 6 AGREE domains were： 17% for scope and purpose（range： 6% to 32%）, 11% for stakeholder involvement（range： 0 to 24%）, 10% for rigor of development（range： 3% to 22%）, 39% for clarity and presentation（range： 25% to 64%）, 11% for applicability（range： 4% to 24%）, and 1% for editorial independence（range： 0 to 15%）. Conclusions： The quality of integrative medicine CPGs was low, the development of integrative medicine CPGs should be guided by systematic methodology. More emphasis should be placed on multi-disciplinary guideline development groups, quality of evidence, management of funding and conflicts of interest, and guideline updates in the process of developing integrative medicine CPGs in China.
文摘Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney transplantation.The American Heart Association and American College of Cardiology joint statement provides guidance on risk stratification for the major cause of heart failure for these patients in its recommendations for coronary heart disease.Herein we provide an overview of the available literature on risk strati-fication for nonischemic heart failure and functional heart disease states such as pulmonary hypertension.Many of these options for optimizing these patients be-fore transplant include optimizing their volume status,often with more agg-ressive ultrafiltration.Kidney transplantation remains the treatment of choice for patients with advanced kidney disease and cardiac disease,the correction of the azotemic substances with kidney transplantation has been associated with imp-roved survival than remaining on dialysis long-term.The findings in the studies reviewed here are expected to help clinicians refine current strategies for evalua-ting potential kidney transplant recipients.
文摘目的:对预防结直肠癌术后肠梗阻临床实践指南进行质量评价及内容分析,为我国预防结直肠癌术后肠梗阻的实践提供参考。方法:检索苏格兰院际指南网、国际指南协作网、新西兰指南工作组等指南网站,检索促进术后恢复学会、美国结肠和直肠外科医师学会、美国胃肠病学会等肠梗阻相关网站,检索PubMed、Web of Science、中国知网、万方数据知识服务平台等数据库发布的结直肠癌术后肠梗阻相关指南,检索时限为2011年1月1日—2021年12月1日。由2名研究者独立对文献进行筛选和资料提取,采用临床指南与评价系统Ⅱ(AGREEⅡ)对指南进行评价,汇总分析预防结直肠癌术后肠梗阻的推荐内容。结果:共纳入相关指南5篇,纳入指南的总体质量评价为2篇A级、3篇B级。AGREEⅡ中6个领域平均标准化得分分别为范围和目的85.55%、参与人员67.78%、严谨性70.00%、清晰性86.67%、应用性53.33%、独立性78.33%。通过内容分析,最终出两大主题、29条推荐意见。结论:纳入的5篇指南总体质量一般,评价分析后得到的预防结直肠癌术后肠梗阻的部分推荐意见内容宽泛,需要不同程度的完善。
文摘目的甄选高质量早泄诊治医患沟通指南,促进医患之间更加有效和富有同理心的沟通,并为后续制定高质量指南提供参考。方法计算机检索中英文数据库,补充医脉通、用药助手、丁香园等网站的指南,使用临床实践指南研究与评价系统Ⅱ(appraisal of guidelines,research and evaluation,AGREEⅡ)和医疗保健实践指南的报告项目(reporting items for practice guidelines in heal thcare,RIGHT)检查表来评估符合条件的临床实践指南的方法和报告质量,计算评审者对组内相关系数(intra-class correlation coefficient,ICC)的总体一致性。结果共纳入3份指南,每个领域评审人员的总体一致性是可以接受的。AGREEⅡ评价结果显示,3篇指南推荐级别均为B级,3篇指南6个领域的平均报告率为44.07%,其中领域一最高(92.59%),领域六最低(16.67%)。RIGHT评价结果显示,指南平均报告率为24.08%。结论早泄诊治医患沟通指南质量有待提高,指南制订者应严格按照AGREEⅡ和RIGHT的要求规范撰写,重视对患者的情感关怀,以期提高临床早泄的诊治效率,并为后续制定高水平指南提供参考。
文摘目的:系统评价新生儿经外周静脉置入中心静脉导管(PICC)管理的临床实践指南,并对文献结果展开分析,以得到准确的评价结论。方法:检索范围包括英国国家卫生与临床优化研究所(NICE)、国际指南协作组(GIN)、BMJ Clinical Evidence、中国临床指南文库医脉通等网页、JBI循证实践数据库、Up To Date、PubMed、EMbase、Web of Science、the Cochrane Library、中国生物医学文献服务系统、中国知网、万方数据库、维普等数据库,检索时限为建库至2021年10月。分析时主要遵循指南中的具有代表意义和权威性的指标,借助临床指南研究与评价系统Ⅱ(AGREEⅡ)得到评价结果,对证据进行汇总。结果:入选具备一定研究价值的文献5篇,均为指南研究,其中A级3篇、B级2篇。从适应证、人员资质、导管选择、血管选择、无菌技术及皮肤消毒、辅助用物、尖端定位、输液接头、敷料更换、冲管与封管、疼痛管理、PICC拔管、并发症的预防及处理13个方面共总结28条证据。结论:现有证据表明,新生儿PICC管理循证指南整体质量较高,推荐意见涵盖内容较为丰富,对提高PICC置管与维护管理指导临床实践有一定的参考意义,在指导临床实践过程中需要充分考虑具体医疗机构环境,切实推动PICC实践标准化。
文摘Cholangiocarcinoma(CC)is the second most common primary liver tumour.High-quality guidelines are essential for effective patient stratification and individualised treatment.This study aimed to appraise the methodological quality of existing guidelines for the resection of CC using the Appraisal of Guidelines for Research&Evaluation(AGREE II)instrument.A systematic search of the literature in Cochrane,PubMed,Google Scholar,and Embase was performed.Assessment of the clinical practice guidelines(CPGs)and consensuses was performed using the AGREE II instrument by four clinicians experienced in surgical practice and the AGREE II appraisal method.Literature searches identified 13 guidelines of highly variable quality according to the AGREE II criteria.The guidelines scored well in certain domains such as scope&purpose(median score across all guidelines;65%),clarity of presentation(76%),and editorial independence(56%).However,they scored poorly for applicability(13%),rigour of development(30%),and stakeholder involvement(39%).None of the 13 guidelines was recommended universally for use without modification.Overall,the methodological quality of guidelines on the surgical management of CC is poor.Future updates should address and modify shortcomings detected by the AGREE II instrument,thereby facilitating better patient stratification and individualised treatment strategies.
文摘目的使用指南研究与评价工具Ⅱ(AGREEⅡ)评价儿童青少年维生素D(VD)临床实践指南(VD指南),反映目前儿童青少年补充VD的基本共识和存在的争议。方法制定VD指南的纳入标准和检索策略,检索PubMed、Web of Science、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库、美国国立指南文库(NGC)、指南国际网络(G-I-N)等相关指南数据库,按纳入标准纳入有关儿童青少年VD指南,提取和描述VD指南AGREEⅡ评价信息,使用AGREEⅡ评价纳入指南质量,使用组内相关系数(ICC)进行评价员间一致性检验。分析比较不同VD指南推荐内容的共识和差异。结果共纳入9篇VD指南,分别来自美国、中国、加拿大、法国、波兰和澳大利亚/新西兰。发表年度从2006至2012年。3篇为循证指南,其中2篇采用GRADE证据分级系统,1篇采用AHRQ证据分级系统;其余6篇为非循证指南。①指南质量经AGREEⅡ评分显示:6大领域的评分中,范围和目的、清晰性和应用性的总体平均得分均>50%,指南制定的参与人员、制定的严谨性和编辑的独立性有待加强(平均得分分别为48%、42%和28%);循证指南在指南的参与人员、制定的严谨性、编辑的独立性方面优于非循证指南。②总体归纳不同VD指南之间在推荐内容上有5个方面的主要差异。VD预防建议:各指南基本认同的是0～1岁婴儿400IU·d-1的VD缺乏预防量是安全的;VD治疗建议:美国(ES)指南推荐2000 IU·d-1(1～18岁),维持6周;阳光照射:美国和澳大利亚/新西兰的指南持不同推荐意见;VD2或VD3:不同指南推荐意见不同;25羟维生素D(25OHD)水平:各指南基本认同25OHD水平<30nmol·L-1时,佝偻病的患病率增加;孕妇及哺乳期妇女:各指南推荐这一人群要注意及时补充VD,或维持适宜的25OHD水平。结论①纳入VD指南整体质量仍有待提高。循证指南质量在指南的参与人员、制定的严谨性、编辑独立性方面优于非循证指南。②纳入VD指南推荐内容虽有一定的差异,但对于0～18岁人群400 IU·d-1的VD缺乏预防量被认为是安全的剂量。③中国VD指南推荐内容参考了国外高质量的指南,改编和制定国内高质量的指南迫在眉睫。
