ObjectivesTo evaluate the reporting status of conflict of interest and economic evidence in Chinese clinical practice guidelines published in 2017 and to provide implications for the guideline development in China.MethodsCNKI, WanFang Data and Google Scholar were electronically searched to collect clinical practice guidelines published in 2017 from January 1st to December 31st, 2017. Two authors independently screened literature, extracted information of interest, such as conflict of interest disclosure and economic evidences, then, the analysis was performed by using the Microsoft Excel 20013 software.ResultsA total of 53 guidelines were included; in which, 14 (26.42%) disclosed conflict of interest, 10 (18.87%) stated sources of funding, and 6 (11.32%) mentioned economics evidence.ConclusionIn China, inadequate attention is addressed to the conflict of interest disclosure and economics evidence during the development of clinical practice guidelines. We propose the inclusion of conflict of interest and economics evidence disclosure in clinical practice guidelines, which will improve their objectivity, independence, and transparency.
This study was an interpretation study based on the standard of AGREEⅡ. It analyzed methodological perspective of the International Evidence-Based Recommendations for Focused Cardiac Ultrasound determined by the International Conference on Focused Cardiac UltraSound (IC-FoCUS).
Pathologic myopia-associated macular neovascularization (MMN) is a prevalent clinical ophthalmic condition characterized by pathological changes including lacquer cracks, choroidal neovascularization, and Fuchs spots. Recent advancements in fundus imaging technologies and diagnostic equipment have provided novel perspectives and strategies for the diagnosis, staging, treatment, and follow-up of MMN. The continuous development of various anti-vascular endothelial growth factor agents has effectively preserved visual acuity in pathologic myopia-associated macular neovascularization patients. However, in the clinical practice of MMN, there are still many challenges, such as the lack of unified disease definitions and staging criteria, differences in the criteria for assessing disease activity, the absence of standardized treatment protocols, and the urgent need for optimized follow-up strategies. To address these issues, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association and Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association jointly developed the Expert consensus on standardized diagnosis and treatment of pathologic myopia-associated macular neovascularization in China based on the principles of evidence-based medicine. This consensus systematically outlines the core elements of MMN diagnosis and treatment, including disease definitions and clinical staging criteria, identification of high-risk factors, diagnostic procedures, follow-up management protocols, assessment of disease activity, selection of individualized treatment strategies, criteria for re-treatment, and long-term follow-up strategies. It provides ophthalmologists at all levels with a scientifically standardized and clinically applicable guide. The consensus particularly emphasizes the implementation of precision medicine in clinical practice, and stresses that individualized treatment decisions should be made within the framework of standardized care, taking into account the patient’s visual needs, lesion characteristics, treatment response, and socioeconomic factors.
By employing the nominal group technique, as per the process standard of the EQUATOR Collaboration Network, experts were selected through purposeful sampling. Two rounds of nominal group discussions were conducted, and the essential information of the utilization of the consensus method was extracted from the literature. After comparison, discussion, evaluation, and optimization, a list of 3 fields, 11 themes, 63 necessary items, and 28 supplementary items was eventually constructed to upgrade the standardization and rigor of the application of the consensus method in the future, assisting guideline developers to plan the consensus process.
Primary osteoporosis is a common metabolic disease in China, causing immense disease and economic burden to patients, their families and the society. Prevention is an important strategy to reduce the disease burden of primary osteoporosis. Calcium, as a basic element for maintaining bone health, plays an important role in the prevention of primary osteoporosis. This guideline was initiated by the Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee. The standard methodology for the development of evidence-based clinical practice guidelines of the World Health Organization (WHO) was employed. A multidisciplinary guideline working group was formed. Delphi method was used to select and eventually identified 15 key clinical questions. Systematic evaluation was carried out on each of the key clinical question and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to formed 15 recommendations, providing guidance for standardizing the clinical practice of calcium supplementation in prevention of primary osteoporosis in adults in China.
Currently, there is a lack of clarity and standardization regarding the implementation details of interventions in traditional Chinese medicine clinical practice guidelines (CPGs). This in methodological guidance for standardizing the implementation prescription adversely impacts the quality of implementation and hinders the clinical application rate of recommendations. Through in-depth analysis of implementation prescription of evidence-based CPGs in traditional Chinese medicine, we identified the challenges associated with standardization. In response, we propose enhancing the technical specifications of implementation prescriptions, advocating for improved formulation processes, diverse reporting approaches, and standardizedological guidelines. These recommendations aim to serve as a methodological reference and guidance for clinical practice guideline developers.
Clinical practice guidelines (CPGs) serve as the cornerstone of medical decision-making, with evaluation tools such as AGREE and RIGHT designed to ensure that these guidelines are grounded in the best available evidence and contribute to enhancing healthcare quality. This article reviews the historical development and current status of CPG evaluation tools, examining their diversity, complexity, application challenges, and inconsistencies in evaluation outcomes. A thorough discussion is provided on the strengths and weaknesses of existing evaluation tools, along with proposed future developmental directions. It is recommended that future efforts prioritize the creation of more streamlined tool designs, foster enhanced international collaboration strategies, and incorporate artificial intelligence technologies. These initiatives aim to improve both the efficiency and accuracy of evaluative processes while facilitating advancements in healthcare practices towards elevated quality standards.
Neuromuscular disease (NMD) encompasses a group of disorders that affect motor neurons, peripheral nerves, neuromuscular junctions, and skeletal muscles, potentially leading to respiratory muscle impairment and decline in respiratory function, significantly impacting patients' quality of life. In March 2023, clinical practice guideline titled Respiratory Management of Patients with Neuromuscular Weakness was released by the American College of Chest Physicians. This article summarizes, categorizes, and interprets the contents and key points of the guideline, aiming to provide more targeted guidance for clinical healthcare professionals and ultimately enhance the effectiveness of respiratory management for patients with NMD.
Objective To systematically review the requirements of patient participation in clinical practice guidelines (CPGs) in Chinese and foreign guideline development manuals. Methods Thirty-six authoritative society websites and guideline databases and 5 commonly used databases were searched online. Relevant information on patients’ participation in the guideline manuals was collected, summarized, and analyzed. Results A total of 37 manuals (33 foreign and 4 Chinese) were included. The requirements for the number of patients, the right to speak, status equality, and the right to vote in the guideline development manual accounted for 35.1%, 13.5%, 8.1%, and 5.4%, respectively. The requirements for participants’ mode of participation were not mentioned in the guideline development manuals from 2000 to 2010. There were 6 (16.2%) in 2011–2015 and 12 (32.4%) in 2016–2022. The comprehensive guidelines for multiple disease types accounted for 35.7%, 28.6%, and 57.1%, respectively, in terms of requirements for participants’ knowledge or experience, management of specialized personnel, and training support. The specific guidelines for a certain type of disease or drug accounted for 21.7%, 4.3%, and 17.4%, respectively; fifteen (40.5%) guideline development manuals mentioned the specific collection forms of patients’ values and preferences in guideline development. Conclusion Given changes to medical models and the emphasis on patients’ rights and interests, an increasing number of manuals have proposed requirements that consider the expression of patients’ values and preferences in manual development, and the dimensions of manual development are constantly enriched. However, manuals outlining the requirements of patient participation are still not comprehensive and can continue to improve.
Rapid, living evidence-based points, as a new model promoting the rapid translation of evidence, aim to integrate the current best evidence, clinical status, public/patient preferences and values, and provide concise and practical guidance rapidly to important questions concerned in clinical medicine and public health. This paper introduces the methodological framework for the development of "Rapid, Living Evidence-Based Points" from 4 aspects: initiation and planning, evidence search and review, development, update, publication and dissemination of evidence-based points, in order to provide a reference for domestic scholars in developing rapid, living evidence-based points.