OBJECTIVE: To critically appraise the methodological quality of clinical practice guidelines for headache produced over the last two decades, including those covering specific interventions using Traditional Chinese M...OBJECTIVE: To critically appraise the methodological quality of clinical practice guidelines for headache produced over the last two decades, including those covering specific interventions using Traditional Chinese Medicine.METHODS: The guidelines on headache disorders were obtained by searching a number of databases, including Pub Med, EMBASE, Web of Science,Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, and Wanfang database, three guideline-related databases [Guideline-International Network, National Guideline Clearinghouse, and Medlive], and the records of organizations that develop guidelines. The publication date was limited to the period from January 1996 to June 2015. The search terms "headache", "headache disorders", "cephalalgia", "migraine", "tension-type headache", "practice guideline", "consensus ", "statement", "regulation", and "recommendation" were used in the "Me SH" and "Free-text" fields. The guidelines were independently appraised by four researchers using the Appraisal of Guidelines for Research and Evaluation Ⅱ instrument.RESULTS: A total of 23 guidelines published between 1998 and 2014 were reviewed. The overall consistency of the four appraisers was good [interclass correlation coefficient 0.84; 95% confidence interval(CI) 0.82-0.86]. The mean(standard deviation) scores for scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence were 52.1(18.0), 39.5(17.1), 33.4(21.0), 49.8(21.9),23.8(19.3), and 24.2(23.7). Only two guidelines were recommended, 12 were recommended with modification, and nine were not recommended.CONCLUSION: Physical Traditional Chinese Medicine therapies were recommended to treat headache. The overall quality of headache guidelines was low in China, but evidence-based guidelines are gradually becoming mainstream. Guideline developers should carefully consider, in particular,three domains: rigor of development, applicability,and editorial independence.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
目的运用指南研究与评价Ⅱ(AGREEⅡ)工具评价国内外双相临床指南的方法学质量。方法以"双相障碍(bipolar disorder)""临床指南(clinical guideline)"等为检索词,通过计算机检索中国知识资源总库、中国科技期刊数据...目的运用指南研究与评价Ⅱ(AGREEⅡ)工具评价国内外双相临床指南的方法学质量。方法以"双相障碍(bipolar disorder)""临床指南(clinical guideline)"等为检索词,通过计算机检索中国知识资源总库、中国科技期刊数据库、万方数据检索系统、中国生物医学文摘数据库、PubMed、OVID、BMJ Best Practice、Dynamed、ISI Web of Knowledge、美国国家指南交换库(NGC)以及国际指南网络(G-I-N)等网站,并辅以手动检索,收集国内外符合该研究标准的临床指南。依据AGREEⅡ工具,对其方法学质量进行评价。结果共纳入17个双相障碍临床指南。AGREEⅡ标准化总体得分显示:陈述清晰性(83%)、范围和目的(69%)领域较高,开发严谨性(40%)和参与人员(31%)领域次之,编辑独立性(25%)和应用性(15%)领域最低。循证指南在开发严谨性、陈述清晰性、应用性、参与人员以及范围和目的 5个领域的得分均高于专家共识指南。中国双相障碍防治指南在编辑独立性领域得分为0,低于其他14个循证指南的总体得分。结论纳入的双相障碍临床指南总体质量与AGREEⅡ标准差距较大。建议今后指南开发制定或更新过程中更多采用AGREEⅡ工具作为参考。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
目的：系统评价绝经激素治疗（MHT）循证临床实践指南。方法：计算机检索PubMed、Web of Science、美国国家指南库（national guideline clearinghouse，NGC）、国际指南网（guideline intemational network，GIN）及新西兰指南组（New ...目的：系统评价绝经激素治疗（MHT）循证临床实践指南。方法：计算机检索PubMed、Web of Science、美国国家指南库（national guideline clearinghouse，NGC）、国际指南网（guideline intemational network，GIN）及新西兰指南组（New Zealand Guidelines Group，NZGG）、中国期刊全文数据库和万方数据库，纳入MHT循证临床实践指南，检索时限为2005-2015年，采用指南研究与评价工具Ⅱ（Appraisal of Guidelines for Research and Evaluation Ⅱ，AGREEⅡ）评价指南方法学质量。提取指南中MHT的主要药物雌激素（E）、孕激素（P）、E＋P、替代药物替伯龙（Tibolone）和雷洛昔芬（Rolaxifene）对适用人群可能带来的利益、风险和使用方法，并通过核对数据后制戍清单。结果：纳入的6篇指南整体质量较好，其中5个指南的总体得分≥60％，仅北美绝经学会指南评分为58％。在范围和目的、参与人员、严谨性、清晰性、应用性、编辑独立性各领域的平均得分依次为81％、74％、67％、74％、53％、65％，应用性领域平均得分最低（53％）。所有指南均强调MHT实践应注意个体化，应充分考虑不同个体的生理情况，评估MHT利益和风险，同时需征求患者意愿。评估的内容包括对患者年龄、绝经类型及年限、绝经症状程度及MHT效用、MHT后心血管疾病及肿瘤风险、家族史等。5个指南推荐使用雌激素最低有效剂量缓解绝经期症状。结论：纳入研究的6个MHT循证临床实践指南整体质量较好，在MHT指南更新或制定新指南时应加强应用性领域的考虑。在MHT的临床实践中应体现个体化原则，做好风险和利益评估工作。激素使用的剂量方面提倡个体化使用雌激素最低有效剂量缓解绝经期症状。展开更多
目的：对导尿管相关尿路感染预防指南进行评价，为临床导尿管相关标准化护理方案及指南实践的质量改进方案制订提供重要依据。方法检索国内外数据库和指南网，按照纳入排除标准筛选指南。描述性分析指南的名称、发表年份、发表机构、指...目的：对导尿管相关尿路感染预防指南进行评价，为临床导尿管相关标准化护理方案及指南实践的质量改进方案制订提供重要依据。方法检索国内外数据库和指南网，按照纳入排除标准筛选指南。描述性分析指南的名称、发表年份、发表机构、指南制定方法、参考文献数目等一般特征资料。使用指南研究与评价工具AGREE Ⅱ对纳入指南的质量进行评价。结果纳入5部指南，1部语种为中文、其他4部均为英语。质量评价结果显示5部指南清晰性领域得分最高，平均分为72％；其次分别为独立性领域（64％）、目的和范围领域（62％）、严谨性领域（53％）、应用性领域（46％）；参与人员领域最差（44％）。其中，3位评价者一致认为美国疾病预防控制中心2010年发布的Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009为推荐指南，另外建议有3部可经过相应修订后使用。结论导尿管相关尿路感染预防指南质量参差不齐，临床实践中指南的确定及选择应根据方法学质量评价结果并参考临床条件、现状等最终选取。展开更多
基金Supported by the Special Research Project of Traditional Chinese Medicine of Guangdong Hospital of Chinese Medicine(No.YN2015MS22)the Science planning project of Guangzhou(No.2014Y2-00040)
文摘OBJECTIVE: To critically appraise the methodological quality of clinical practice guidelines for headache produced over the last two decades, including those covering specific interventions using Traditional Chinese Medicine.METHODS: The guidelines on headache disorders were obtained by searching a number of databases, including Pub Med, EMBASE, Web of Science,Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, and Wanfang database, three guideline-related databases [Guideline-International Network, National Guideline Clearinghouse, and Medlive], and the records of organizations that develop guidelines. The publication date was limited to the period from January 1996 to June 2015. The search terms "headache", "headache disorders", "cephalalgia", "migraine", "tension-type headache", "practice guideline", "consensus ", "statement", "regulation", and "recommendation" were used in the "Me SH" and "Free-text" fields. The guidelines were independently appraised by four researchers using the Appraisal of Guidelines for Research and Evaluation Ⅱ instrument.RESULTS: A total of 23 guidelines published between 1998 and 2014 were reviewed. The overall consistency of the four appraisers was good [interclass correlation coefficient 0.84; 95% confidence interval(CI) 0.82-0.86]. The mean(standard deviation) scores for scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence were 52.1(18.0), 39.5(17.1), 33.4(21.0), 49.8(21.9),23.8(19.3), and 24.2(23.7). Only two guidelines were recommended, 12 were recommended with modification, and nine were not recommended.CONCLUSION: Physical Traditional Chinese Medicine therapies were recommended to treat headache. The overall quality of headache guidelines was low in China, but evidence-based guidelines are gradually becoming mainstream. Guideline developers should carefully consider, in particular,three domains: rigor of development, applicability,and editorial independence.
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。
文摘目的运用指南研究与评价Ⅱ(AGREEⅡ)工具评价国内外双相临床指南的方法学质量。方法以"双相障碍(bipolar disorder)""临床指南(clinical guideline)"等为检索词,通过计算机检索中国知识资源总库、中国科技期刊数据库、万方数据检索系统、中国生物医学文摘数据库、PubMed、OVID、BMJ Best Practice、Dynamed、ISI Web of Knowledge、美国国家指南交换库(NGC)以及国际指南网络(G-I-N)等网站,并辅以手动检索,收集国内外符合该研究标准的临床指南。依据AGREEⅡ工具,对其方法学质量进行评价。结果共纳入17个双相障碍临床指南。AGREEⅡ标准化总体得分显示:陈述清晰性(83%)、范围和目的(69%)领域较高,开发严谨性(40%)和参与人员(31%)领域次之,编辑独立性(25%)和应用性(15%)领域最低。循证指南在开发严谨性、陈述清晰性、应用性、参与人员以及范围和目的 5个领域的得分均高于专家共识指南。中国双相障碍防治指南在编辑独立性领域得分为0,低于其他14个循证指南的总体得分。结论纳入的双相障碍临床指南总体质量与AGREEⅡ标准差距较大。建议今后指南开发制定或更新过程中更多采用AGREEⅡ工具作为参考。
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.
文摘目的：系统评价绝经激素治疗（MHT）循证临床实践指南。方法：计算机检索PubMed、Web of Science、美国国家指南库（national guideline clearinghouse，NGC）、国际指南网（guideline intemational network，GIN）及新西兰指南组（New Zealand Guidelines Group，NZGG）、中国期刊全文数据库和万方数据库，纳入MHT循证临床实践指南，检索时限为2005-2015年，采用指南研究与评价工具Ⅱ（Appraisal of Guidelines for Research and Evaluation Ⅱ，AGREEⅡ）评价指南方法学质量。提取指南中MHT的主要药物雌激素（E）、孕激素（P）、E＋P、替代药物替伯龙（Tibolone）和雷洛昔芬（Rolaxifene）对适用人群可能带来的利益、风险和使用方法，并通过核对数据后制戍清单。结果：纳入的6篇指南整体质量较好，其中5个指南的总体得分≥60％，仅北美绝经学会指南评分为58％。在范围和目的、参与人员、严谨性、清晰性、应用性、编辑独立性各领域的平均得分依次为81％、74％、67％、74％、53％、65％，应用性领域平均得分最低（53％）。所有指南均强调MHT实践应注意个体化，应充分考虑不同个体的生理情况，评估MHT利益和风险，同时需征求患者意愿。评估的内容包括对患者年龄、绝经类型及年限、绝经症状程度及MHT效用、MHT后心血管疾病及肿瘤风险、家族史等。5个指南推荐使用雌激素最低有效剂量缓解绝经期症状。结论：纳入研究的6个MHT循证临床实践指南整体质量较好，在MHT指南更新或制定新指南时应加强应用性领域的考虑。在MHT的临床实践中应体现个体化原则，做好风险和利益评估工作。激素使用的剂量方面提倡个体化使用雌激素最低有效剂量缓解绝经期症状。
文摘目的：对导尿管相关尿路感染预防指南进行评价，为临床导尿管相关标准化护理方案及指南实践的质量改进方案制订提供重要依据。方法检索国内外数据库和指南网，按照纳入排除标准筛选指南。描述性分析指南的名称、发表年份、发表机构、指南制定方法、参考文献数目等一般特征资料。使用指南研究与评价工具AGREE Ⅱ对纳入指南的质量进行评价。结果纳入5部指南，1部语种为中文、其他4部均为英语。质量评价结果显示5部指南清晰性领域得分最高，平均分为72％；其次分别为独立性领域（64％）、目的和范围领域（62％）、严谨性领域（53％）、应用性领域（46％）；参与人员领域最差（44％）。其中，3位评价者一致认为美国疾病预防控制中心2010年发布的Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009为推荐指南，另外建议有3部可经过相应修订后使用。结论导尿管相关尿路感染预防指南质量参差不齐，临床实践中指南的确定及选择应根据方法学质量评价结果并参考临床条件、现状等最终选取。
