Appraisal of Clinical Practice Guidelines for Ischemic Stroke Management in Chinese Medicine with Appraisal of Guidelines for Research and Evaluation Instrument:A Systematic Review

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.

Characteristics and quality of clinical practice guidelines for diabetic kidney disease:a systematic review

OBJECTIVE:To assess the quality of Clinical practice guidelines(CPGs)in the context of diabetic kidney disease(DKD)and determine whether any factors affect the quality.METHODS:We searched eight databases along with five international and national organizations to develop or archive guidelines from their inception to July 2023,with an additional search of medlive.cn.And the authoritative organizations related to nephrology.CPGs and consensus statements created using direct differential diagnosis or therapy for DKD were included without language restrictions.Their quality was evaluated by four reviewers using the Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ)instrument.Along with the item and domain scores,the guideline was also allocated an overall quality score,which ranged from 1(lowest possible quality)to 7(highest possible quality).Moreover,an overall recommendation for use was also assigned(“recommended”,“recommended with modifications”or“not recommended”).RESULTS:A total of 16 CPGs were included,of which 14 were from Asia and the remaining two from Europe.These two CPGs were updated in the third version.Six CPGs were recommended for use because their primary domains scored in the medium or high category.Furthermore,five CPGs were recommended with modifications as the stakeholder involvement,applicability,and editorial independence domains were evaluated as low categories.In all domains,the lowest average score was for rigour of development(33%),followed by application(36%),and stakeholder involvement(51%).The highest average score was for scope and purpose(79%),followed by clarity of presentation(75%).None of the CPGs considered the patient's viewpoint,and six of 16 CPGs did not use any grading system to translate the evidence into recommendations.Additionally,only three of 16 CPGs shared search strategy,and eight of 16 CPGs did not declare a funding source.CONCLUSIONS:According to the AGREE II evaluation,more than one in four CPGs for DKD had poor methodological quality.Enhanced efforts are needed to advance the rigour of development,application,and editorial independence of DKD guideline panels for most guidelines.Stakeholders,CPG developers,and CPG users should consider methodological quality while choosing CPGs,and interpret and implement their issued suggestions.

Development and preliminary verification of the evaluation system for clinical practice guidelines in China

Objective:Clinical practice guidelines can improve healthcare processes and patient outcomes;however,the quality of these guidelines varies greatly in China.The aim of this study was to construct a comprehensive instrument for the appraisal of clinical practice guidelines in China(AGREE-CHINA),and to validate its reliability as a tool for helping potential guideline users in assessing guideline quality.Methods:First,an interdisciplinary working group was established for developing the methods.They also created a checklist as a tool according to the Appraisal of Guidelines,Research and EvaluationⅡ(AGREEⅡ)standards,considering the particularity of Chinese clinical practice.Next,the first draft of AGREE-China was developed by vote,modification,preliminary trial,and crossverification.To ensure the objectivity,credibility,and reproducibility of the draft assessment,all of the checklists and standards were cross-reviewed fairly widely.Fin ally,AGREE-CHINA and AGREEⅡwere used to assess the Chinese guideli nes published in the past five years,and the results were compared.Results:The presented AGREE-CHINA covered five main checkpoints(science and rigor,effectiveness and safety,economy,usability and feasibility,and conflicts of interest)with each point divided into several more specific checkpoints.Definitions and rationales for each main checkpoint appear in the Appendix.The quality ratings based on the total scores of AGREE-China and AGREEⅡwere consistent(r=0.508,P=0.020).Compared with AGREEⅡ,the study showed a higher level of interraterreliability for AGREE-CHINA overall(ICC=0.957,P<0.001).The mean time required for AGREE-CHINA was less than that for AGREEⅡ:this was approximately 30 minutes for every assessment.User satisfaction was generally high.Conclusions:This paper has presented the first edition of the AGREE-CHINA appraisal tool for clinical guidelines.It is quick and easy to use;it assesses and performs well in comparison to AGREEⅡ.This first version of AGREE-CHINA will require further development and validation.

Quality Assessment of Clinical Practice Guidelines for Integrative Medicine in China:A Systematic Review

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.