全球上消化道癌筛查指南的质量评价

目的 系统评价国内外现有上消化道癌（包括食管癌和胃癌）筛查指南的方法学质量，为今后同类指南的制定和更新提供标准和参考依据。方法 本研究系统检索中国知网、万方数据知识服务平台、中国生物医学文献数据库、中国临床指南文库、PubMed、The Cochrane Library和Embase等数据平台建库至2020年8月发表的文献，并同时检索国际癌症研究机构、国际指南协作网的机构官网刊登的指南作为补充。纳入标准为食管癌或胃癌筛查的独立指南，且符合美国医学研究所对指南的定义；排除标准包括指南的摘要、解读及评价类文献、重复发表、已更新的原始版指南以及食管癌或胃癌临床治疗或实践指南。采用指南研究和评估工具（AGREE Ⅱ）和国际实践指南报告标准（RIGHT）对上消化道癌筛查指南的质量和报告规范程度进行比较和评价。结果 共纳入6篇食管癌筛查指南，5篇胃癌筛查指南。AGREE Ⅱ质量评价结果显示，11篇指南整体质量参差不齐，其中推荐等级为"A"的有2篇、等级为"B"的有1篇、等级为"C"的有5篇、等级为"D"的有3篇；各指南在范围和目的、清晰性领域得分较高，食管癌筛查指南在严谨性、独立性领域得分差异较大，胃癌筛查指南在参与人员、应用性领域得分普遍较低。RIGHT评价结果显示，11篇指南报告质量有待提高，报告质量较差的6个条目分别为背景、证据、推荐意见、评审和质量保证、资金资助和利益冲突以及其他方面。结论 纳入的上消化道癌筛查指南的质量整体一般，规范性有待加强。     

全球前列腺癌筛查指南质量评价

目的系统评价现有前列腺癌筛查指南的方法学质量和报告质量,为今后同类指南的制定和更新提供参考。方法以前列腺癌、前列腺肿瘤、筛查、筛检、指南、共识、规范、标准、prostate cancer、prostate carcinoma、prostate tumor、screening、early detection、guideline、recommendation等为关键词系统检索中国知网、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library,并同时检索机构官网发布的指南作为补充。采用开发指南研究和评估工具Ⅱ(AGREEⅡ)和国际实践指南报告标准(RIGHT)对纳入指南的方法学质量和报告质量进行比较和评价。结果经过筛选后共纳入13部指南。AGREEⅡ评价结果显示,推荐等级为A级的有10部、B级的有2部、C级的有1部;13部指南在参与人员、应用性领域得分均较低,平均得分分别为52.1%和34.0%。RIGHT评价结果显示,13部指南的报告质量一般,报告质量较差的条目主要集中在证据(64.6%)、资金资助和利益冲突(44.2%)、其他方面(46.2%)3个领域。结论我国目前尚无前列腺癌筛查指南。本研究纳入的前列腺癌筛查指南方法学质量整体良好,可为我国指南制定提供参考,但报告质量一般,规范性有待进一步加强。     

全球乳腺癌筛查指南质量评价

目的对已发表的乳腺癌筛查指南进行质量评价,为我国乳腺癌筛查指南的制订提供借鉴和参考。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、中国生物医学文献服务系统、维普网和万方数据知识服务平台中乳腺癌筛查指南,检索时间为建库至2020年8月。由2名研究人员独立筛选文献和提取资料,采用开发指南研究和评估工具Ⅱ(AGREEⅡ)和国际实践指南报告标准(RIGHT)对纳入的指南进行质量评价。结果共纳入15部乳腺癌筛查指南,其中7部由美国发布,发表年份主要集中在2015-2019年,11部指南有更新版本。AGREEⅡ评价结果显示,严谨性(47.0%±22.1%)和应用性(44.0%±15.1%)得分较低,RIGHT评价结果显示,评审和质量保证(46.7%±39.9%)及资金资助和利益冲突(41.7%±24.4%)报告较差。根据AGREEⅡ整体得分推荐使用的指南共有6部,修改后推荐使用的指南有9部;RIGHT报告水平良好的指南有4部,报告水平一般的指南共11部。综合质量最好的是美国国立综合癌症网络2018年发布的指南(AGREEⅡ:83.3%,RIGHT:80.0%)和美国癌症学会2015年发布的指南(AGREEⅡ:83.3%,RIGHT:85.7%)。结论乳腺癌筛查指南的质量以中等质量为主,应加强对指南的制订过程和质量控制等内容的关注。     

全球肝癌筛查指南及共识质量评价

目的系统评价全球肝癌筛查指南/共识的方法学质量,为我国肝癌筛查循证指南的制定提供参考依据。方法系统检索PubMed、Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献服务系统等中、英文数据库中肝癌筛查指南/共识,同时搜集相关指南制订机构作为补充。检索时间截至2020年6月30日。由2名研究人员独立进行文献筛选和信息提取。采用开发指南研究和评估工具Ⅱ(AGREEⅡ)和国际实践指南报告标准(RIGHT)对纳入的指南进行质量评价。结果共纳入19部肝癌筛查指南/共识,发布时间为2003-2019年。AGREEⅡ评价结果显示,纳入指南的质量较高,其中9部指南推荐为A级,5部指南推荐为B级。各指南在范围和目的、参与人员、清晰性领域得分较高。RIGHT评价结果中以基本信息报告率最高(56.1%),背景(37.5%)和推荐意见(39.8%)报告质量尚可。证据(35.8%)、评审和质量保证(18.4%)、资金资助和利益冲突(22.4%)以及其他方面(21.0%)4个领域的质量待改善。结论肝癌筛查指南质量尚可,但在证据、评审和质量保证、资金资助和利益冲突方面仍有待加强。我国尚缺乏肝癌筛查的独立的循证医学指南。     

全球结直肠癌筛查指南及共识质量评价

目的系统评价结直肠癌筛查指南/共识的方法学和报告质量,为我国结直肠癌筛查工作的开展以及指南/共识的制定提供参考依据。方法系统检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献服务系统、PubMed、Embase、Web of Science、Cochrane Library和Guidelines International Network,并同时检索美国预防服务工作组、美国癌症学会等刊登的筛查指南/共识作为补充,选择2020年9月1日前发表的所有中、英文结直肠筛查指南/共识。采用开发指南/共识研究和评估工具Ⅱ(AGREEⅡ)和国际实践指南报告标准(RIGHT)对结直肠癌筛查指南/共识进行质量评估。结果经过质控后共纳入19部指南/共识,主要由美国、中国、澳大利亚、加拿大、英国、韩国以及国际组织发布,其中美国发布的指南/共识最多(7部);AGREEⅡ评价结果显示,19部指南/共识整体质量较高,各指南/共识得分均值在范围和目的、清晰性领域得分较高,分别为87.5%和89.6%,但在参与人员(47.0%)、严谨性(42.3%)、应用性(47.5%)和独立性(50.2%)领域表现不佳。其中,整体得分≥50.0%的有12部,推荐等级达到A级的有13部、B级的有2部、C级的有4部;RIGHT评价结果显示,各领域平均报告率分别为基本信息(76.3%)、背景(77.0%)、证据(55.8%)、推荐意见(59.4%)、评审和质量保证(26.3%)、资金资助和利益冲突(43.4%)、其他方面(49.1%)。亚组分析显示,中国6部指南/共识质量与发达国家还有一定的差距。结论结直肠癌筛查指南/共识发布数量呈上升趋势且整体质量较高,但在报告规范性方面有待提高。     

中国营养指南和专家共识质量评价——基于AGREE Ⅱ和RIGHT工具

目的基于AGREE Ⅱ和RIGHT工具,评价中国现存营养指南和专家共识的质量,以期为临床实践及后续指南的制订提供参考。方法检索中英文数据库和医脉通,搜集营养相关指南和专家共识。采用AGREE Ⅱ和RIGHT工具评价指南质量,使用组内相关系数进行一致性检验。结果最终纳入64部指南和专家共识,均为中国发布。AGREE Ⅱ 6个领域标准化得分依次为(64.19%±12.58%)、(31.64%±13.07%)、(23.00%±13.33%)、(54.95%±15.15%)、(23.63%±14.96%)、(32.36%±16.46%)。RIGHT 7个领域报告率依次为(55.47%±49.76%)、(63.28%±48.25%)、(43.13%±49.60%)、(39.95%±49.04%)、(13.28%±38.03%)、(15.63%±36.38%)、(26.56%±44.28%)。结论 64部指南和专家共识的方法质量和报告质量均有待提高。建议未来制订营养指南和专家共识时严格遵循国际标准,提高方法学和报告质量,为临床医护人员和其他人群的营养筛查、评估、治疗等提供高质量参考依据。     

全球肺癌筛查指南及共识质量评价

目的 了解国内外肺癌筛查指南/共识的研究进展和质量，为我国制定高质量的肺癌筛查指南/共识提供参考依据。方法 检索PubMed、Medline、Embase、Cochrane Library、Web of Science、中国知网、中国生物医学文献服务系统、维普网和万方数据知识服务平台共9个数据库和相关网站关于肺癌筛查指南/共识的文献，采用开发指南研究和评估工具Ⅱ（AGREE Ⅱ）和国际实践指南报告标准（RIGHT）评价工具对新发布或更新的指南/共识进行质量评价。结果 共纳入2015-2020年的9部指南/共识，发布的国家包括美国、中国、加拿大、沙特阿拉伯和南非；AGREE Ⅱ评价结果显示，范围和目的及清晰性得分较高，严谨性和应用性得分较低；5部指南被判定为A级，均为国外发布的指南，其余4部为B级，包括中国发布的3部指南/共识以及1部南非发布的指南；RIGHT评价结果显示，基本信息和背景报告率较高，评审和质量保证、资金资助和利益冲突报告率较低，其中，报告水平良好的指南5部，报告水平中等的指南/共识4部。综合质量较高的是美国胸科医师学会2018年发布的指南和加拿大预防保健工作组2016年发布的指南。结论 肺癌筛查指南/共识的发布国家和机构数量逐渐增加，我国的肺癌筛查指南/共识的质量偏低，需结合循证方法制订出适合我国国情的高质量的肺癌筛查指南/共识，以指导实践。     

绝经后骨质疏松症临床实践指南和专家共识的质量评价

目的 采用AGREE Ⅱ工具评价绝经后骨质疏松症的临床实践指南和专家共识,为中国绝经后骨质疏松症指南的制订提供参考依据。方法 通过检索PubMed、EMbase、中国生物医学文献服务系统、中国知网、维普和万方数据库,同时补充检索医脉通数据库、WHO、美国国立临床诊疗指南数据库、英国国家卫生与服务优化研究院等数据库,收集绝经后骨质疏松症的指南和共识,初始检索时限为建库至2022年6月,补充检索时限为建库至2022年9月。由2名研究者独立筛选指南和专家共识并提取资料后,采用AGREE Ⅱ工具对纳入的指南和共识进行质量评价。结果 共纳入29篇指南和共识,AGREE Ⅱ 6个结构域制订平均得分率为91%、52%、38%、79%、37%、56%,组内相关系数检验结果为0.80(P<0.05)。编辑的独立性方面,国外指南或共识得分高于国内指南或共识(Z=-2.763,P<0.05)。指南较共识在应用性领域得分高(Z=-2.387,P<0.05)。2017年之后发表的指南和共识在参与人员和表达清晰性领域比2017年之前的得分高(Z=-2.232,P<0.05;Z=-3.189...     

预防婴幼儿意外窒息指南/共识的质量评价及内容分析

目的 评价有关预防婴幼儿意外窒息的循证指南及共识文献，为预防意外窒息提供依据。方法 系统检索指南发布的主要网站、专业学会网站和电子文献数据库中有关婴幼儿意外窒息的指南文献，并追溯查阅相关参考文献。检索时间为建库至2021年7月31日。应用指南研究和评估工具Ⅱ（AGREE Ⅱ）及JBI循证卫生保健中心专家共识评价标准分别对循证指南和专家共识文献进行质量评价，总结分析各指南中有关预防婴幼儿意外窒息的相关建议。结果 筛选后共纳入6篇文献，最终纳入2篇循证指南、4篇专家共识。2篇循证指南经AGREE Ⅱ评价后，其范围与目的、参与人员、严谨性、清晰性、应用性与独立性6个领域标准化百分比得分分别为88.89%、86.12%、76.52%、86.12%、77.08%、91.67%，均为A级；组内相关系数（ICC）均＞0.75，一致性较高。4篇专家共识各条目的评价结果一致，均为“纳入”。最终归纳形成32条预防婴幼儿意外窒息的推荐建议，包括睡眠环境、用物管理、饮食管理、培训教育、组织政策五个方面。结论 纳入的6篇文献总体质量较好，评价分析后所得到的预防婴幼儿意外窒息的推荐建议可为卫生保健人员开展健康教育提供依据。     

2019年我国外科学临床实践指南方法学质量评价

目的评价2019年我国外科学临床实践指南方法学质量。方法以“指南”为主题检索词,在万方、中国知网、维普和中国生物医学文献等数据库中检索中文核心期刊公开发表的外科学临床实践指南,检索时限为2019年1月1日-12月31日。采用临床指南研究与评估系统（AGREEⅡ）对指南的方法学质量进行评价。结果共纳入29部外科学指南,其中11部有基金资助说明,指南参考文献数平均为77篇。纳入指南在范围和目的、参与人员、严谨性、清晰性、应用性和编辑的独立性领域得分分别为50.00%（33.33%,63.89%）、25.00%（13.89%,41.67%）、20.83%（8.33%,34.38%）、55.56%（38.89%,69.44%）、0%（0%,4.17%）和0%（0%,50.00%）。结论2019年我国外科学临床实践指南总体质量不高。未来指南制定需要在方法学方面进一步提升,尤其是严谨性、应用性和编辑的独立性方面。     

癌症筛查指南及共识质量评价研究进展

癌症筛查是能够降低癌症死亡率的手段之一。标准化的癌症筛查技术指南是提高筛查科学化、规范化及国际化的主要方式。随着指南制定方法学的发展,国内外癌症筛查指南数据不断增长,但质量仍良莠不齐。本文总结国内外目前癌症筛查指南质量评价进展,提出了基于国内外经验和我国癌症筛查指南面对的机遇与挑战,为我国今后癌症筛查高质量服务提供参考依据。     

Appraisal of guidelines developed by the World Health Organization

Objective

To appraise the quality of guidelines developed by the World Health Organization (WHO) that were approved by its Guidelines Review Committee (GRC) and identify strengths and weaknesses in the guideline development process.

Study design

Cross-sectional.

Methods

Three individuals independently assessed GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Scores were standardized across domains and overall quality was determined through consensus.

Results

124 guidelines met inclusion criteria and were assessed. 58 guidelines were recommended for use, 58 were recommended with modifications and eight were not recommended. The highest scoring domains across guidelines were scope and purpose, and clarity of presentation. The recommended guidelines had higher rigor of development and applicability domain scores in comparison to other guidelines. 77% of the guidelines referenced an underlying evidence review and 49% used GRADE to assess the body of evidence or the strength of the recommendation. The domains in need of improvement included stakeholder engagement, editorial independence, and applicability. Guidelines not recommended for use were generally insufficient in their rigor of development.

Conclusions

WHO guidelines need further improvement, most importantly in the rigor of their development (i.e., use of evidence reviews). Other areas for improvement include increased stakeholder engagement, a more explicit process for recommendation formulation and disclosure of interests, discussion of the facilitators, barriers, resource implications, and criteria for monitoring the outcomes of guideline implementation. WHO guidelines can improve through increased transparency, adherence to the WHO Handbook for Guideline Development, and better oversight by the GRC.     

Predictors of high quality clinical practice guidelines: examples in oncology.

OBJECTIVE: Clinical practice guidelines are widely used as effective tools for improving the management of patients with cancer. However, there is increasing concern about variation in guideline quality. In this study we identified predictors for high-quality guidelines in oncology. DESIGN: The quality scores for 32 oncology guidelines from 13 countries were determined by four independent appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. MAIN MEASURE: : The contribution to the quality score of six characteristics of guidelines and three of guideline developing organizations was then assessed using analysis of variance and stepwise linear regression analysis. RESULTS: Some guideline and organizational characteristics were shown to be responsible for a large part of the variations in quality scores. The availability of background information was the strongest predictor of quality with an explained variance ranging from 17% ("Applicability") to 67% ("Rigour of development"). High-quality guidelines were more often produced by government-supported organizations and/or within a structured, coordinated programme. The other characteristics (publication year, type of guideline, format, level of care, and scope) were not independent predictors of quality. CONCLUSIONS: Guidelines should provide more explicit information about the context of their development and methods used in order to improve their quality and thus encourage their use in clinical practice.     

Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument

Although clinical guidelines have an influential role in healthcare practice, their development process and the evidence they cite has been subject to criticism. This study evaluates the quality of guidelines in cardiac clinical practice by examining how they adhere to validated methodological standards in guideline development. A structured review of cardiac clinical practice guidelines published in seven cardiovascular journals between January 2001 and May 2011 was performed. The AGREE II assessment tool was used by two researchers to evaluate guideline quality. A total of 101 guidelines were identified. Assessment of guidelines using AGREE II found methodological quality to be highly variable (median score, 58.70%; range, 45.34–76.40%). ‘Scope and purpose’ (median score, 86.1%) and ‘clarity of development’ (median score, 83.3 %) were the two domains within AGREE II that received the highest scores. Applicability (median score, 20.80%; range, 4.20–54.20%) and editorial independence (median score, 33.30%; range, 0–62.50%) had the lowest scores. There is considerable variability in the quality of cardiac clinical practice guidelines and this has not improved over the last 10 years. Incorporating validated guideline assessment tools, such as AGREE II, may improve the quality of guidelines.     

Quality varies across clinical practice guidelines for mammography screening in women aged 40-49 years as assessed by AGREE and AMSTAR instruments

Objective

To assess the quality of clinical practice guidelines providing recommendations on the frequency of mammography screening in asymptomatic, average-risk women 40-49 years of age.

Study Design and Setting

We searched the National Guideline Clearinghouse and MEDLINE for guidelines published from 2005 to 2010. Five independent assessors rated the quality of each guideline and its underlying evidence review using the Appraisal of Guidelines for Research and Evaluation (AGREE) and Assessment of Multiple Systematic Reviews (AMSTAR) instruments, respectively.

Results

Eleven guidelines were appraised. Ten referenced an underlying evidence review; two referenced the same review. Three reviews were rated good, one was moderate, and five were rated poor quality. On overall assessment of the quality of the guidelines, two were strongly recommended, two were recommended with provisos, and seven were either not recommended or the assessors were unsure whether to recommend it. Most guidelines clearly presented their recommendations, but the rigor of development, applicability, and stakeholder involvement varied. Seven guidelines recommended mammography screening as part of a periodic health examination and four recommended individualized screening in the target population. The latter four guidelines were based on good-quality reviews and three were recommended by the assessors.

Conclusion

Guideline users need to be aware of the variability in quality and identify the high-quality guidelines that meet their needs.     

Reconciling Primary Care and Specialist Perspectives on Prostate Cancer Screening

When specialists propose screening guidelines for primary care clinicians to implement, differences in perspectives between the 2 groups can create conflicts. Two recent specialty organization guidelines illustrate this issue. The American Urological Association guideline panel and National Comprehensive Cancer Network recommend that average-risk men first be counseled about the risks and benefits of prostate-specific antigen screening for prostate cancer at age 40 rather than at the previously recommended age of 50 years. There is no direct evidence, however, that this recommendation has any impact on prostate cancer-specific mortality. To avoid distracting primary care clinicians from providing services with proven benefit and value for patients, professional organizations should follow appropriate standards for developing guidelines. Primary care societies and health care systems should also be encouraged to evaluate the evidence and decide whether implementing the recommendations are feasible and appropriate.Key words: prostate-specific antigen, early detection of cancer, guidelines as topic, evidence-based medicine

Oh, East is East, and West is West, and never the twain shall meet.Rudyard Kipling, The Ballad of East and West