Structured grading and evaluation of clinical questions in clinical practice guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yaqi ^1,2 , GAO Yicheng ^1,2 , SU Chengyuan ^1,2 , LIU Meijun ^1,2 , LI Xun ^1,2,3 ,  FEI Yutong ^1,2,3

1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
2. Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
3. Beijing GRADE Center, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;

Corresponding author：

FEI Yutong, Email: yutong_fei@163.com

Keywords：

Clinical question; PICO; Clinical practice guideline; CPG; Methodology

DOI：

10.7507/1672-2531.202311037

Video：

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In the process of guideline development and construction of clinical questions, it is necessary to guide clinicians to propose clinical problems into PICO (population, intervention, control, outcome) structured clinical questions. However, there are still unclear criteria to define and judge the appropriateness of the width of the PICO elements of a clinical question. Either over wide or over narrow can make the PICO question unsuitable to be a question for clinical practice guidelines to answer. We graded the clinical questions to be eight grades (3, 2, 1, 0, −1, −2, −3, mixed) according to the number of the PIC elements obviously needs to be adjusted to evaluate applicability of the appropriateness of the width of the clinical questions. Our work can provide methodological references for clinicians and guideline developers.

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25.	梁昌昊, 尹冠翔, 王雅琪, 等. 中医药临床实践指南制订和修订中德尔菲法应用的方法流程及建议. 协和医学杂志, 2023, 14(5): 1084-1090.
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27.	陈薇, 郭宇博, 方赛男, 等. 中医药临床实践指南中临床问题的确定. 中国中西医结合杂志, 2020, 40(2): 220-223.
28.	吕爱平, 赵静, 姜淼. 中医证候分类和复杂干预措施是影响中医临床疗效评价的核心问题. 中国中西医结合杂志, 2011, 31(4): 449-451.
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30.	National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. 2021.
31.	胡琳莉, 黄国宁, 孙海翔, 等. CSRM指南共识的制定规范(2016). 生殖医学杂志, 2017, 26(4): 289-301.
32.	Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
33.	British Thoracic Society. British Thoracic Society standards of care committee guideline production manual. 2022.

1. World Health Organization. WHO handbook for guideline development. 2014.
2. Gupta S, Bhattacharyya OK, Brouwers MC, et al. Canadian Thoracic Society: presenting a new process for clinical practice guideline production. Can Respir J, 2009, 16(6): e62-e68.
3. Schardt C, Adams MB, Owens T, et al. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak, 2007, 7: 16.
4. Hoogendam A, de Vries Robbé PF, Overbeke AJ. Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. J Med Libr Assoc, 2012, 100(2): 121-126.
5. Mactier R. Renal Association clinical practice guideline development policy manual. Nephron Clin Pract, 2011, 118(Suppl 1): c13-c25.
6. Rosenfeld RM, Nnacheta LC, Corrigan MD. Clinical consensus statement development manual. Otolaryngol Head Neck Surg, 2015, 153(2 Suppl): S1-S14.
7. American Academy of Neurology. 2017 edition clinical practice guideline process manual. 2017.
8. Langer G, Meerpohl JJ, Perleth M, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. Z Evid Fortbild Qual Gesundhwes, 2012, 106(5): 369-376.
9. Infectious Diseases Society of America. Handbook for clinical practice guidelines development. 2021.
10. National Clinical Effectiveness Committee. Guideline developers manual. 2013.
11. New Zealand Guidelines Group. Handbook for the preparation of explicit evidence-based clinical practice guidelines. 2001.
12. 葛龙. 中医药/中西医结合临床实践指南制订方法学研究进展与展望. 中国药物评价, 2022, 39(4): 279-284.
13. 杨超, 杜世豪, 王舢泽, 等. 基于改良德尔菲法构建《女性尿失禁针灸临床实践指南》临床问题. 中国针灸, 2022, 42(8): 927-931.
14. Monagle P, Cuello CA, Augustine C, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2018, 2(22): 3292-3316.
15. 廖秀莲. 针刺治疗中风偏瘫的临床回顾性研究. 北京: 北京中医药大学, 2012.
16. 吕琳, 吴景东. 不同阶段带状疱疹的中西医治疗研究进展. 实用中医内科杂志, 2024, 3: 1-5.
17. 魏敏, 闫言. 带状疱疹的药物治疗进展. 临床药物治疗杂志, 2019, 17(11): 33-37.
18. Werner RN, Nikkels AF, Marinović B, et al. European consensus-based (S2k) guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: treatment. J Eur Acad Dermatol Venereol, 2017, 31(1): 20-29.
19. Liu ZS, Peng WN, Liu BY, et al. Clinical practice guideline of acupuncture for herpes zoster. Chin J Integr Med, 2013, 19(1): 58-67.
20. 中华医学会骨科分会关节外科学组, 吴阶平医学基金会骨科学专家委员会. 膝骨关节炎阶梯治疗专家共识(2018年版). 中华关节外科杂志(电子版), 2019, 13(1): 124-130.
21. 赖玮婧, 刘芳, 付平. 慢性肾脏病评估及管理临床实践指南解读—从K/DOQI到KDIGO. 中国实用内科杂志, 2013, 33(6): 448-453.
22. 张宏伟, 刘建平. 临床试验中的结局指标及效应测量. 中医杂志, 2007, 48(8): 696-698.
23. National Health and Medical Research Council. Guidelines for guidelines: forming the questions. 2019.
24. 梁昌昊, 尹丁冉, 刘美君, 等. 中医药指南制订中共识法应用关键要素的定性研究. 协和医学杂志, 2024, 3: 1-15.
25. 梁昌昊, 尹冠翔, 王雅琪, 等. 中医药临床实践指南制订和修订中德尔菲法应用的方法流程及建议. 协和医学杂志, 2023, 14(5): 1084-1090.
26. 王郁, 王丽颖, 韩学杰. 基于文献的中医临床实践指南共识法专家遴选指标研究. 中医药学报, 2022, 50(5): 40-43.
27. 陈薇, 郭宇博, 方赛男, 等. 中医药临床实践指南中临床问题的确定. 中国中西医结合杂志, 2020, 40(2): 220-223.
28. 吕爱平, 赵静, 姜淼. 中医证候分类和复杂干预措施是影响中医临床疗效评价的核心问题. 中国中西医结合杂志, 2011, 31(4): 449-451.
29. 高一城, 夏如玉, 王雅琪, 等. 循证临床实践指南中临床问题结构完整性及表述规范性的建议. 中国循证医学杂志, 2023, 23(1): 120-124.
30. National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. 2021.
31. 胡琳莉, 黄国宁, 孙海翔, 等. CSRM指南共识的制定规范(2016). 生殖医学杂志, 2017, 26(4): 289-301.
32. Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
33. British Thoracic Society. British Thoracic Society standards of care committee guideline production manual. 2022.

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