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.

Clinical practice guidelines for treating headache with Traditional Chinese Medicine: quality assessment with the appraisal of guidelines for research and evaluation Ⅱ instrument

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.

Appraisal of the current guidelines for management of cholangiocarcinoma-using the Appraisal of Guidelines Research and Evaluation Ⅱ (AGREE Ⅱ) Instrument

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.

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.

妊娠期使用阿司匹林预防子痫前期的临床实践指南评价

目的:探讨国内外妊娠期使用阿司匹林预防子痫前期相关临床实践指南的质量情况。方法:系统检索2012—2023年发布的妊娠期使用阿司匹林预防子痫前期相关临床实践指南,使用指南研究和评估工具Ⅱ(AGREEⅡ)对纳入指南的质量进行评价分析,并对各指南中的主要推荐内容进行比较和总结。结果:共纳入18部妊娠期使用阿司匹林预防子痫前期相关临床实践指南,其中4部为A级推荐,13部为B级推荐,1部为C级推荐。基于AGREEⅡ的整体指南评价结果显示,在范围和目的、参与人员、严谨性、清晰性、应用性、独立性各领域的平均得分分别为62.96%、60.03%、62.21%、96.14%、43.06%、66.20%。目前,各国指南均推荐具有一定子痫前期风险的妊娠期妇女预防性应用阿司匹林,但对阿司匹林疗程和剂量的推荐具有差异。结论:近10年全球发布的有关阿司匹林预防子痫前期的指南中,中等质量、高质量的指南相对较多,主要的不足集中在应用性领域,以及目标人群观点、证据选择标准和外审专家的参与等项目,需要指南开发者进一步改进。

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.

胃肠道手术ERAS指南/共识质量评价及内容分析

目的 通过评价和分析胃肠道手术加速术后康复(ERAS)指南/共识,遴选推荐使用的高质量指南/共识,为ERAS临床实践提供决策依据。方法 计算机检索PubMed、Embase、万方、中国知识基础设施工程等数据库及指南相关网站,纳入自数据库建库至2023年7月的胃肠道手术ERAS指南/共识。应用指南研究与评估系统Ⅱ和国际实践指南报告规范对纳入研究的指南/共识进行质量评价。分析整理推荐使用的高质量指南,汇总推荐意见。结果 最终纳入8部指南、13部共识。基于应用指南研究与评估系统Ⅱ,各领域平均标准化得分:范围和目的 64.22%±14.47%、参与人员29.68%±15.43%、制定的严谨性30.26%±18.76%、表达的明晰性73.68%±19.06%、应用性10.05%±11.39%、编辑独立性54.46%±36.58%,其中3部指南推荐使用。基于国际实践指南报告规范,指南背景、证据和推荐意见领域存在严重报告缺失(报告率<10%)。基于3部推荐使用的指南,汇总提出术前、术中和术后三部分24条推荐意见。结论 胃肠道手术ERAS指南/共识质量参差不齐,3部推荐使用。

神经根型颈椎病临床实践指南和专家共识方法学与报告质量评价

目的评价神经根型颈椎病(CSR)临床实践指南和专家共识(简称指南/共识)的方法学质量和报告质量。方法系统检索PubMed、Embase、WOS、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方(WanFang)、VIP和相关指南发布平台、专业学会网站在2022年8月前收录的CSR指南/共识。依据纳入排除标准完成文献筛选与数据提取后,采用指南研究和评价工具Ⅱ(AGREEⅡ)和卫生保健实践指南的报告条目(RIGHT)清单对指南/共识的方法学质量和报告质量进行评价。结果共纳入指南/共识5部。AGREEⅡ领域得分自高而低依次为范围和目的(76.94%)、独立性(62.08%)、清晰性(58.06%)、参与人员得分(44.17%)、严谨性(43.13%),和应用性(29.17%)。RIGHT清单条目报告率为0~100.00%,报告充分(条目报告率60.00%)的条目占28.57%,完全未报告的条目占报告不充分条目的32.00%;RIGHT清单领域报告率除评审和质量保障领域与基本信息领域(50.00%),其余各领域均未超过35.00%。结论现有的CSR中英文指南/共识方法学质量和报告质量均有待提高。未来研究者应参照AGREEⅡ和RIGHT清单等国际标准进行CSR指南/共识的制定或更新与报告。

妊娠期深静脉血栓形成预防指南的质量评价

目的:对国内外妊娠期深静脉血栓形成(VTE)预防相关指南的质量进行评价,为临床妊娠期妇女VTE的管理提供循证证据。方法:检索专业学会网站、临床实践指南、医脉通网站等,检索时限为2011年1月1日至2021年1月1日。采用评价系统Ⅱ(AGREEⅡ)对纳入指南进行评价。结果:共纳入6篇指南,1篇共识;AGREEⅡ评价6个领域,清晰性(75.00%)得分最高,范围和目的(67.46%)得分次之,参与人员(47.89%)和应用性(33.33%)最低;指南总体推荐级别为2篇A级(推荐),分别为2018年美国血液病学会(ASH)和2020年昆士兰卫生组织(QLD)指南;2篇B级(修改后推荐),分别为2012年美国脑科医师学会(ACCP)和2015年英国皇家妇产科医师学会(RCOG)指南;3篇C级(不推荐),分别为2014年加拿大妇产科医生协会(SOGC)、2018年美国妇产科医师学会(ACOG)和2021年中国的指南。结论:现有的妊娠期妇女VTE预防指南总体质量参差不齐,参与人员与应用性方面需进一步提升,临床医生可以根据QLD指南VTE风险评分表进行评估,药物首选低分子肝素。

基于AGREEⅡ的儿童细菌性脑膜炎药物治疗循证指南的质量评价

目的探讨儿童细菌性脑膜炎药物治疗相关指南的现状与质量,为儿童细菌性脑膜炎药物治疗方案选择提供参考。方法系统检索PubMed、Embase、CNKI、万方数据、CBM等国内外各大医学和行业机构网站数据库,检索时间为建库起至2021年4月,收集儿童细菌性脑膜炎药物治疗相关指南。应用指南研究与评价(AGREEⅡ)工具对纳入指南进行质量评价与分析。结果共纳入来自5个国家和1个地区的9部指南。4名评价员对每个领域的组内相关系数一致度中等(ICC范围0.700~0.766)。AGREEⅡ评价结果显示,纳入指南在“范围与目的”(平均领域分值为86.11%±7.12%)、“参与人员”(80.56%±5.68%)、“制定的严谨性”(78.01%±10.46%)、“清晰性”(77.30%±9.64%)和“编辑的独立性”(72.69%±18.00%)方面得分较好,均超过70%。各指南疾病诊断和治疗方案选择的整体推荐意见类似,在新生儿用药、糖皮质激素辅助用药等领域循证证据不足,推荐尚存争议。结论纳入儿童细菌性脑膜炎药物治疗相关循证指南的整体质量中等偏上,在新生儿用药领域的证据尚有待提高。

基于AGREEⅡ的儿童癫痫药物治疗指南质量评价

目的:探讨国内外儿童癫痫治疗相关指南的现状并进行质量评价,为优化临床实践指南提供参考。方法:检索PubMed、MedLine、EMBase、中国知网、万方等数据库和相关网站,纳入儿童癫痫治疗相关指南,采用AGREEⅡ工具进行方法学质量评价。评价内容包括范围和目的、参与人员、制定的严谨性、表达的清晰性、应用性及独立性,并对推荐主要内容进行比较分析。结果:多数指南提及了不同癫痫发作类型及儿童癫痫综合征的一、二线用药及添加治疗,各指南的推荐内容略有不同。经评价,美国癫痫协会、英国国家卫生与临床优化研究所、苏格兰校际指南网、国际抗癫痫联盟、美国神经病学学会的指南质量较高,属于强推荐。结论:儿童癫痫药物治疗指南整体质量较高,但仍需进一步优化。

缺血性脑卒中中医康复治疗指南的系统评价

目的:系统评价缺血性脑卒中中医康复治疗指南的质量,为指南的制定规范提供借鉴。方法:计算机检索数据库:PubMed、国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库,检索指南相关网站:卫生保健规范研究所(NICE)、国际网指南(GIN)数据库,梅斯医学数据库,中华中医药学会标准化委员会网站(http://www.cacm.org.cn/category/zyzn/bzh/)、中国中西医结合学会网站(http://www.caim.org.cn/),检索时限为建库至2021年9月,收集缺血性脑卒中中医康复治疗指南。应用研发与评价指南评估Ⅱ(AGREEⅡ)工具对纳入指南进行质量评价,并汇总中等质量及以上的指南推荐意见。结果:共纳入13部指南,AGREEⅡ的平均得分分别为范围和目的65.67%、参与人员43.02%、严谨性43.64%、清晰性63.82%、应用性19.87%和独立性32.05%。13部指南中7部指南为中等质量,6部指南为低质量。本研究得到23条中医康复治疗的推荐意见,其中2条为强推荐。结论:指南总体质量不高,未来指南的制定应该从指南应用性、严谨性和独立性方面规范,同时重视开展高质量的临床研究,为指南的制定提供证据支持。

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.

《临床指南研究与评价系统Ⅱ》简介

临床指南在医患临床决策和卫生政策制定时起着重要作用。在指南制定过程中由于方法学和制定策略的不足,导致指南的质量良莠不齐,因此,对指南进行研究和评价具有重要意义。2003年发表的第1版《临床指南研究与评价系统》(Appraisal of Guidelines for Researchand Evaluation,AGREE)对指南的质量保证和成功实施产生了重要作用,目前已得到广泛支持和认同。2009年,AGREE国际协作组织对2003版AGREE修正后制定出新的AGREE即AGREEⅡ。目前,AGREEⅡ已取代2003版AGREE,但国内尚没有AGREEⅡ的相关介绍。本文作者对AGREEⅡ作一介绍,以期其利于指南的研究和评价。

基于AGREE Ⅱ对糖尿病足预防与管理循证指南的评价研究

目的评价糖尿病足预防与管理相关的最佳实践指南,为临床决策及我国临床实践指南的制定提供参考意见。方法计算机检索加拿大安大略省注册护士协会、苏格兰院际指南协作网、英国国家卫生与临床优化研究所、新西兰校际指南协作网、美国国立指南网、国际指南协作网等循证指南数据库,根据纳入排除标准筛选公开发表的有关糖尿病足的临床实践指南。采用临床指南研究与评估系统对检索到的相关指南进行方法学质量评价,使用组内相关系数进行评价者间一致性检验,并进行各指南推荐意见的内容分析。结果共纳入6部临床实践指南,指南总体质量评价为4个A级,2个B级。指南在6个领域的AGREE Ⅱ评价得分范围在70.83%~87.04%之间;6部指南的组内相关系数介于0.642~0.951。结论纳入的糖尿病足临床实践指南总体质量较高,可以为我国糖尿病足预防与管理的临床实践指南的制定提供证据支持,但是将国外指南应用于我国临床环境之前必须经过严格的本土化过程。

AGREEⅡ评价9个儿童青少年维生素D临床实践指南及推荐意见共识和差异

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。

儿童病毒性脑炎药物治疗循证指南的系统评价

目的系统评价儿童病毒性脑炎的相关指南,为临床循证用药提供参考。方法计算机检索Pub Med、EMbase、CBM、万方、CNKI、维普等数据库;以及NGC、GIN、TRIP等指南数据库和各大医学行业机构网站如CDC、IDSA、AAP、WHO、中国卫生和计划生育委员会、中国临床指南文库和中国临床指南协作网。检索时限从建库或建网至2014年10月。2位研究者依纳入与排除标准独立筛选文献,采用指南研究与评价的评审工具Ⅱ(AGREEⅡ)评价指南质量,使用组内相关系数(ICC)进行一致性检验。结果最终纳入3部指南,均为近5年发布,分别来自英国、美国和欧洲。指南最终推荐均为B级,在AGREEⅡ6个领域中"范围和目的 "得分最高,平均68.54%。得分较低的是"应用性"和"编辑的独立性"。对疑似患儿应尽早经验予阿昔洛韦治疗。确诊为单纯疱疹和水痘带状疱疹病毒性脑炎,亦推荐使用阿昔洛韦。但推荐级别不同,前者为强推荐,后者推荐强度降低。此外,单纯疱疹病毒性脑炎患儿暂不推荐使用糖皮质激素;而水痘带状疱疹,可使用激素作为备选治疗,但证据尚不充分。对于巨细胞病毒脑炎推荐更昔洛韦联合膦甲酸,不建议使用西多福韦;肠病毒脑炎可以使用普拉康纳利。结论各指南推荐的治疗病毒性脑炎的药物基本一致,但制定循证指南在编辑的独立性以及应用性上要进一步加强。

儿童中耳炎循证指南AGREEⅡ质量评价情况

目的评价儿童中耳炎临床实践指南质量,为临床医师及药师鉴别高质量的指南。方法计算机检索中国知网、万方数据库、维普、中国生物医学文献数据库、PubMed、Embase及医脉通官网、国际指南联盟、美国儿科协会、国家指南数据库、英国国家卫生和临床示范研究所等网站,检索时限为2000年1月至2019年6月。中文检索词为中耳炎、临床实践指南、儿童,英文检索词包括otitis media、middle ear、glue ear、guideline、guidance、child、children。纳入儿童中耳炎临床实践指南,应用临床指南研究与评价系统(AGREEⅡ)对指南质量进行评价。结果纳入指南10篇,包括5篇循证指南、5篇非循证指南。3名研究者评定各指南结果一致性较高,10篇指南评定结果分别为英国(ICC=0.876,F=22.271,P<0.001)、美国1(ICC=0.861,F=19.509,P<0.001)、美国2(ICC=0.819,F=14.587,P<0.001)、日本(ICC=0.853,F=18.531,P<0.001)、韩国(ICC=0.856,F=18.894,P<0.001)、新南威尔士(ICC=0.865,F=20.277,P<0.001)、中国(ICC=0.836,F=16.258,P<0.001)、加拿大1(ICC=0.894,F=26.342,P<0.001)、加拿大2(ICC=0.880,F=22.997,P<0.001)、国际(ICC=0.795,F=12.605,P<0.001),差异有统计学意义。10篇指南总体质量不高,其中1篇为A级,4篇为B级,5篇为C级,各领域中“清晰性”与“范围与目的”得分较高,分别为70.2%与67.8%,而“编辑独立性”与“应用性”得分相对较低,分别为34.0%与29.7%。结论纳入指南质量相对较低,我国现有的儿童中耳炎临床实践指南质量不高,建议采用循证制定的方法,制订符合我国国情的循证指南。

指南研究与评价的评审工具

目前全球各医疗网站和数据库中有各类各样的临床实践指南,其质量参差不齐。本文详细介绍一种国际上指南研究与评价的评审工具以供读者参考,其目的是为临床实践指南的质量评估提供一个审查工具,使读者在采用或实施该指南前能对其作一个正确的评估。

儿童青少年高血压临床治疗指南质量的系统性评价

目的循证评价儿童青少年高血压临床治疗指南质量,比较推荐建议的异同,为临床医师与药师提供用药参考。方法计算机检索CNKI、万方数据库、VIP、CBM、PubMed、医学文摘(EMBASE)及医脉通官网(Medlive)、国际指南联盟(GIN)、美国儿科协会(AAP)、国家指南数据库(NGC)、英国国家卫生和临床示范研究所(NICE)等网站,检索时限为建库至2018年10月。纳入儿童青少年高血压相关临床指南,应用指南研究与评价系统Ⅱ(AGREEⅡ)工具对指南质量进行系统评价,比较分析各指南推荐治疗建议的差异。结果3篇指南分别来自欧洲高血压学会(ESH)、AAP、加拿大高血压教育计划(CHEP)。AGREEⅡ系统6大领域中仅"清晰性"和"范围与目的 "得分较高,AAP与CHEP指南为B级,ESH指南为C级,指南的推荐治疗建议基本一致。结论纳入指南质量需要进一步提高,在今后制订儿童青少年高血压指南时,应加强指南制定的严谨性与应用性,最好可以采用循证评价的方法,得到高质量的指南,为临床上儿童高血压治疗提供最佳证据。