ObjectiveTo evaluate the efficacy and safety of pirfenidone in patients with idiopathic pulmonary fibrosis. MethodsPubMed, Cochrane Library, CNKI, CBM, Wanfang, and VIP databases were searched for randomized controlled trials of pirfenidone as interventions for the treatment of idiopathic pulmonary fibrosis. According to the Cochrane system evaluation method, the methodological quality of included studies was evaluated and the effective data were extracted. The meta-analysis was performed with RevMan 5.2 software. ResultsSix studies were included with 1727 patients in total. Compared with placebo groups, pirfenidon could improve the changing rate of vital capacity at the end of the treatment[WMD=0.06, 95% CI (0.01, 0.12), Z=2.48, P=0.01; heterogeneity inspection χ2=1.03, P=0.31]. Pirfenidon could not improve the changing rate of lowest SpO2 in 6-minute walking test[WMD=0.82, 95% CI (-1.35, 2.98), Z=0.74, P=0.46; heterogeneity inspection χ2=8.90, P=0.003] and could not reduce the mortality[RR=0.62, 95% CI (0.37, 1.03), Z=1.85, P=0.06; heterogeneity inspection χ2=3.05, P=0.55]. The incidences of photosensitivity, dizziness, nausea, abdominal discomfort, joint pain, fatigue in pirfenidone group were more frequent than those in placebo group. ConclusionsBecause of lack of enough eligible studies and defects in design and reporting data in the studies, this meta-analysis can not evaluate pirfenidone's long-term efficacy and safety. Hence, the existed clinical evidences can't support pirfenidone to be the treatment of IPF medication.
ObjectiveTo investigate the reporting of search strategies of clinical practice guidelines (CPGs) in China. MethodsWe electronically searched WanFang Data, VIP, CNKI and CBM for clinical practice guidelines developed in China from inception to December 2012. Two reviewers independently screened guidelines, extracted data, and analyzed search strategies in these guidelines. ResultsA total of 380 Chinese CPGs were included, of which, only 13 reported search strategies of evidence, 9 in China reported search terms, 5 reported retrieval time of Chinese CPGs, and only 3 completely reported search terms, retrieval time and search databases. ConclusionThe reporting rate of search strategies of evidence in Chinese CPGs is fairly low and Chinese CPGs lack unified reporting criteria. We suggest that the developers of Chinese guideline should apply the reporting items of AGREE Ⅱ and the criteria of Conference on Guideline Standardization (COGS) to report CPGs.
ObjectiveTo investigate primary healthcare workers' knowledge, attitude and behaviour, and explore the way of guidelines' popularization, application and surveillance mechanism in primary healthcare institutions. MethodsHealthcare workers in seven township hospitals in Gaolan county, Gansu province were given a questionnaire to test their knowledge, attitudes and behaviour regarding Clinical practice guidelines. ResultsAmong the 143 distributed questionnaires, 143 valid were retrieved. The results showed that 80% of respondents knew the guidelines and 51% had used guidelines in treatment, 32% obtained guidelines mainly through distribution by affiliations. The most popular type of guidelines was self-developed by native departments. Respondents (37%) considered difficult availability of guidelines major barriers to popularization, 74% failed to receive training about guidelines, 88% looked forward to special organizations in charge of disseminating guidelines and conducting related training on how to apply guidelines. ConclusionPrimary healthcare workers report low awareness of, attention to and compliance with clinical practice guidelines. The greatest challenge for guidelines' popularization in township hospitals is difficult availability and it is of vital importance for primary institutions to enhance guidelines' implementation and strengthen learning and conduct training.
Objective To evaluate the quality of Chinese clinical practice guidelines published in domestic medical journals in 2011. Methods The following 4 Chinese databases including WanFang Data, VIP, CNKI and CBM were searched from January 2011 to December 2011. The quality of included guidelines was assessed by using AGREE II. Results A total of 75 guidelines published in 2011 were included. Among them, 10 guidelines (13%) stated the conflict of interest, 10 guidelines (13%) mentioned evidence-based developing, 5 guidelines (7%) performed evidence grading system, 8 guidelines (11%) performed recommendation strength grading system, and 4 guidelines (5%) performed both evidence and recommendation strength grading systems. The ratio of the 6 domains’ scores of AGREEⅡ were as follows: scope and purpose (18%), stakeholder involvement (11%), rigour of development (8%), clarity of presentation (34%), applicability (5%), and editorial independence (14%). Conclusion Compared with the guidelines published before, the guidelines of 2011 have a higher quality and some of them are progressively standardized in developing methodology.