ObjectiveTo evaluate the quality of traditional Chinese medicine (TCM) guidelines, so as to provide evidence for developing similar guidelines. MethodsWe systematically searched TCM guidelines published in domestic medical journals from WanFang Data, VIP, CNKI and CBM. We also searched Google, Amazon.cn and dangdang.com by hand in order to obtain TCM guidelines published in monographs. And we used AGREE II instrument to assess the methodological quality of included guidelines. ResultsA total of 115 guidelines (87 published in domestic medical journals and 28 published in monographs) were included. Scaled domain percentages from highest to lowest were:scope and purpose (41%), stakeholder involvement (28%), clarity of presentation (33%), rigour of development (20%), editorial independence (9%) and applicability (7%). ConclusionThere is still a large gap about methodological quality between TCM guidelines and international guidelines. So the guideline developers should systematically search, evaluate and synthesize the evidence based on structured problems. At the same time, they also need to consider the costs of recommendations, the implementation environment and the patients' preference and values. On this basis, the developer could further increase the transparency and independence during developing TCM guidelines.
With the perspective of evidence-based medicine, this review aims to investigate the effectiveness and safety of off-label drug use of bevacizumab for eye disease, and explore the barriers to further study. And then, suggestions for the supported evidence and clinical use of off-label drug use will be provided based on this case.
The biggest advantages of network meta-analysis (NMA) are to compare the effectiveness of different interventions about one conditions using a quantitative way, pool the results of direct comparison and indirect comparison, and rank the effectiveness based on outcomes, so as to select the best decision for patients. In the paper we introduce the methods of applying GRADE system to NMAs based on the papers published by GRADE working group and other relative studies. The steps of using GRADE to NMAs are mainly based on four aspects: firstly, presenting direct and indirect effect estimates and 95% CI; secondly, rating of quality of direct and indirect estimates; thirdly, presenting the results of NMAs; and the last step is to rating the quality of NMA effect estimates. The methods of rating the quality of direct comparison are the same to use GRADE in traditional meta-analysis. The rating of the quality of the indirect estimates is based on the ratings of the two pairwise estimates that contributes to the indirect estimate of the comparison of interest. The lower confidence rating of the two direct comparisons constitutes the confidence rating of the indirect comparison. When both direct and indirect evidence are available, we suggest using the higher of the two quality ratings as the quality rating for NMA estimate. The four steps of rating the quality of NMA from GRADE working group have promoted the theoretical system of NMA. But the process requires the evaluators to be familiar with GRADE system, and conduct pilot test to make sure the evaluators had understood the items of GRADE system correctly. In addition, we also need to concern that the non-transitivity among different groups and the inconsistency between direct comparison and indirect comparison.
For the purposes of promoting the effect of secondary prevention of myocardial infarction, and improving the compliance with myocardial infarction (MI) secondary prevention, a guideline for strengthening patients self-management on non-pharmacological secondary prevention was produced by an multidiscipline team leaded by Chinese Association of Integrative Medicine clinical cardiovascular branch, Lanzhou University Evidence-Based Medicine Center, Peking University School of Nursing, Tianjin University of Traditional Chinese Medicine and Beijing University of Chinese Medicine. This is the first version of patient guideline in China. This paper introduces the main methods, processes and characteristics of the patient guideline development. It will provide reference to future researchers to the development of the patient guideline.
In order to help Chinese guideline developers, clinicians, health policy makers and other relevant researchers fully understand and make appropriate use of World Health Organization (WHO) guidelines, Chinese GRADE Center and Guidelines Review Committee of World Health Organization (WHO-GRC) have written a series of papers about development methods, review principles and the structure and content of WHO guidelines. This is the third (also last) paper which interpreted Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection and Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection as examples with the process and steps of WHO guideline development.