胃癌筛查领域指南方法学质量和报告质量的系统评价

目的系统评价国内外现有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。方法以“指南”“共识”“规范”“标准”“胃癌”“胃部肿瘤”“筛查”“筛检”“诊断”“Gastric Cancer”“Gastric Tumor”“guideline”“recommendation”“Early Detection of Cancer”“Screening”为检索关键词,系统检索中国知网、万方知识服务平台、中国生物医学文献数据库、中国临床指南文库、PubMed、The Cochrane Library、EMBASE、Web of Knowledge等数据库截止到2018年9月的中、英文文献,并同时检索美国预防服务工作组、美国癌症学会、国际癌症研究机构、澳大利亚癌症委员会、国际指南协作网的机构官网刊登的指南作为补充。纳入标准为胃癌筛查的独立指南文件,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胃癌临床治疗或实践指南。采用欧洲指南研究与评估工具(AGREEⅡ)和实践指南报告标准(RIGHT)对胃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5篇指南。AGREEⅡ质量评价结果显示,5篇指南整体质量参差不齐,其中推荐等级为“A”的有1篇,等级为“B”的有1篇,等级为“C”的有3篇;各指南在范围和目的、清晰性领域得分较高,在严谨性、独立性领域得分差异较大,在参与人员、应用性领域得分普遍较低。RIGHT评价结果显示,5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、资金资助与利益冲突声明和管理以及其他方面。结论纳入的胃癌筛查指南的质量整体一般,规范性有待加强。     

Systematic review to inform prevention and management of chronic disease for Indigenous Australians: overview and priorities

Objective: To describe the main characteristics of systematic reviews addressing questions of chronic disease and related risk factors for Indigenous Australians. Methods: We searched databases for systematic reviews meeting inclusion criteria. Two reviewers assessed quality and extracted characteristics using pre‐defined tools. Results: We identified 14 systematic reviews. Seven synthesised evidence about health intervention effectiveness; four addressed chronic disease or risk factor prevalence; and six conducted critical appraisal as per current best practice. Only three reported steps to align the review with standards for ethical research with Indigenous Australians and/or capture Indigenous‐specific knowledge. Most called for more high‐quality research. Conclusion: Systematic review is an under‐utilised method for gathering evidence to inform chronic disease prevention and management for Indigenous Australians. Relevance of future systematic reviews could be improved by: 1) aligning questions with community priorities as well as decision maker needs; 2) involvement of, and leadership by, Indigenous researchers with relevant cultural and contextual knowledge; iii) use of critical appraisal tools that include traditional risk of bias assessment criteria and criteria that reflect Indigenous standards of appropriate research. Implications: Systematic review method guidance, tools and reporting standards are required to ensure alignment with ethical obligations and promote rigor and relevance.     

Historical review on development of environmental quality standards and guideline values for air pollutants in Japan

Environmental quality standards (EQSs) have been established as desirable levels to be maintained for protection of human health and the conservation of the living environment by Basic Environment Law. EQSs in ambient air had been set for 10 substances (sulfur dioxide (SO(2)), carbon monoxide (CO), suspended particulate matter (SPM), nitrogen dioxide (NO(2)) and photochemical oxidants (Ox), benzene, tetrachloroethylene, trichloroethylene, dioxins and dichloromethane) and guideline values for 7 (acrylonitorile, vinyl chloride monomer, mercury, nickel compounds, 1,3-butadiene, chloroform and 1,2-dichloromethane) in Japan by 2009. EQSs for the classical (or traditional) air pollutants, SO(2), CO, SPM, NO(2) and Ox, were set according to the minimal requirement to protect human health, based on evidence from epidemiological studies conducted before the 1970s. In 1996, the Central Environment Council designated substances which may be hazardous air pollutants and substances requiring priority action, and adopted the concept of risk assessment to set EQSs and guideline values. A life-long risk level (virtually safe dose) of 10(-5) was used to set EQS for benzene, and guideline values for vinyl chloride monomer, nickel compounds, and 1,3-butadiene. EQSs for trichloroethylene, tetrachloroethylene and dichloromethane, and guideline values for acrylonitorile and mercury were set using uncertain factors and lowest observed adverse effect (LOAEL)/no observed adverse effect level (NOAEL). The results of animal experiments were utilized to set guideline values for chloroform and 1,2-dichloroethane. The benchmark approach and human equivalent concentration (HEC) were adopted for 1,2-dichloroethane. The history of setting EQSs and guideline values for hazardous air pollutants is one of adopting new concepts into risk assessment.     

Prevalence of chronic kidney disease in population-based studies: Systematic review

Background  

Chronic kidney disease (CKD) is becoming a major public health problem worldwide. This article reviews the published evidence of prevalence of CKD in population-based study samples that used the standardized definition from the Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation (K/DOQI) practice guideline, and particularly focus on performance of serum-creatinine based equations for GFR estimation. We provide a summary of available data about the burden of CKD in various populations.     

Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy

Background  

Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF) produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program.     

New technologies for chronic disease management and control: a systematic review

We conducted a systematic review of the clinical effectiveness of interventions using information and communication technologies (ICTs) for managing and controlling chronic diseases. Electronic databases were searched for randomized clinical trials that assessed the effectiveness of ICTs (except for those that included only telephone communication) and measured some clinical indicator. Information was reviewed and assessed independently by two researchers. Of the 950 clinical trials identified, 56 studies were identified for potential inclusion. Of those, 24 were finally included: 5 studies in asthma, 3 in hypertension, 1 in home telecare, 7 in diabetes, 6 in heart failure and 2 in prevention heart disease. Overall, ICT applications did not show an improvement in clinical outcomes, although no adverse effects were identified. However, ICTs used in the detection and follow up of cardiovascular diseases provided better clinical outcomes, mortality reduction and lower health services utilization. Systems used for improving education and social support were also shown to be effective. At present the evidence about the clinical benefits of ICTs for managing chronic disease is limited.     

Formal consensus: the development of a national clinical guideline

BACKGROUND: There is currently a political enthusiasm for the development and use of clinical guidelines despite, paradoxically, there being relatively few healthcare issues that have a sound research evidence base. As decisions have to be made even where there is an undetermined evidence base and that limiting recommendations to where evidence exists may reduce the scope of guidelines, thus limiting their value to practitioners, guideline developers have to rely on various different sources of evidence and adapt their methods accordingly. This paper outlines a method for guideline development which incorporates a consensus process devised to tackle the challenges of a variable research evidence base for the development of a national clinical guideline on risk assessment and prevention of pressure ulcers. METHOD: To inform the recommendations of the guideline a formal consensus process based on a nominal group technique was used to incorporate three strands of evidence: research, clinical expertise, and patient experience. RESULTS: The recommendations for this guideline were derived directly from the statements agreed in the formal consensus process and from key evidence-based findings from the systematic reviews. The existing format of the statements that participants had rated allowed a straightforward revision to "active" recommendations, thus reducing further risk of subjectivity entering into the process. CONCLUSIONS: The method outlined proved to be a practical and systematic way of integrating a number of different evidence sources. The resultant guideline is a mixture of research based and consensus based recommendations. Given the lack of available guidance on how to mix research with expert opinion and patient experiences, the method used for the development of this guideline has been outlined so that other guideline developers may use, adapt, and test it further.     

Systematic review of economic evaluations and cost analyses of guideline implementation strategies

To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies, we conducted a systematic review of such studies published between 1966 and 1998. Studies were assessed against BMJ economic evaluations guidelines for each stage (guideline development, implementation and treatment). Of 235 studies identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient, 38 reported treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and 2 guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Thus, very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence-based guidelines. Additional data for tables are available on request from the authors.     

A systematic review evaluating the potential for bias and the methodological quality of meta-analyses in vaccinology

A systematic review was undertaken to produce an annotated bibliography of meta-analyses in vaccinology and to evaluate their methodological quality. Based on our evaluation using the Oxman and Guyatt index, the methodological quality of the 121 meta-analyses included in this study is not satisfactory. The most frequent limitations include non-comprehensive bibliographic research; bias in the selection of the studies; lack of quality assessment of individual studies; absence of evaluation of heterogeneity among studies and publication bias. The methodological quality significantly increases with the year of publication and with declared financial support, without differences between profit and non-profit support. Meta-analyses with a higher Oxman and Guyatt quality score are more likely to include only randomized trials and to explore appropriately potential sources of heterogeneity. Most of the methodological deficiencies of meta-analyses in vaccinology could be corrected easily, and meta-analysts should improve the methodological quality of their work to maintain their impact on policy decisions.     

NKF-K/DOQI和慢性肾脏病的调脂治疗

发现慢性肾脏病(CKD)常伴发血脂异常已近两个世纪。早在1811年Blackall就对两者的相关性进行过报道。但直到近20余年来,“表现为血脂异常的脂质代谢异常及调脂治疗在CKD中的重要意义”才得以认识。纵观CKD调脂治疗的进展可分为以下三个阶段:(1)基本忽略不治。(2)以维护慢性肾脏病中的“病肾”为主要出发点,积极进行调脂治疗(3)美国肾脏基金会(NKF)制定的“慢性肾脏病/透析病人生存质量指南(K/DOQI)”则提出应以防治慢性肾脏病患者的心血管疾病(CVD)及提高其生存率为主要治疗目的,从而CKD的调脂治疗进入规范性治疗时期。一、K/DO…     

The relationship between organizational climate and quality of chronic disease management

Objective. To test the utility of a two‐dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. Data Sources/Study Setting. Secondary data were obtained from 223 primary care clinics in the Department of Veterans Affairs health care system. Study Design. Organizational climate was defined using the dimensions of task and relational climate. The association between primary care organizational climate and diabetes processes and intermediate outcomes were estimated for 4,539 patients in a cross‐sectional study. Data Collection/Extraction Methods. All data were collected from administrative datasets. The climate data were drawn from the 2007 VA All Employee Survey, and the outcomes data were collected as part of the VA External Peer Review Program. Climate data were aggregated to the facility level of analysis and merged with patient‐level data. Principal Findings. Relational climate was related to an increased likelihood of diabetes care process adherence, with significant but small effects for adherence to intermediate outcomes. Task climate was generally not shown to be related to adherence. Conclusions. The role of relational climate in predicting the quality of chronic care was supported. Future research should examine the mediators and moderators of relational climate and further investigate task climate.     

Systematic review of quality of life in Turner syndrome

Purpose

This study aimed to systematically review the available literature on “quality of life” (QoL) or “health-related quality of life” (HRQoL) in Turner syndrome (TS) patients and to analyze the relations among height, puberty, and the use of growth hormone (GH) and the QoL of TS patients.

Methods

An electronic bibliographic search was conducted through the PubMed, Embase, Bireme, Scopus, and Web of Science databases. The main terms were “Quality of Life” and “Turner syndrome.”

Results

Among the databases, 559 articles were found; after the selection process, 13 studies were selected. A quality assessment was conducted, and all the studies were of high quality. Eight well-known QoL questionnaires were used, and the selected studies presented factors that may be related to the QoL of TS patients, such as height, puberty, and GH use. However, a more detailed understanding of which factors are associated with the QoL of TS patients is still needed, which may be due to the lack of specific QoL instruments involving important aspects related to TS.

Conclusion

The QoL of TS patients appears to be compromised, but existing data regarding the relations among height, puberty, and GH and QoL are still controversial. Although these factors should be carefully considered in TS patients, it was not possible to determine whether they have a significant relation with the QoL of TS patients.

     

疾病负担研究的方法学进展——疾病负担综合评价

目前 ,全球均受到传染病与非传染病的威胁 ,发展中国家尤其严重。在卫生资源相对不足且分布不均衡的情况下 ,如何对不同疾病的危害进行综合评价 ,以达到公平、合理、有效地分配有限的卫生资源 ,确定优先发展的卫生领域和优先解决的卫生问题 ,是 WHO和各国政府在卫生决策中面临的共同问题。不同疾病对人群健康的危害一直受到人们的关注 ,多维的健康结局要求建立一个多维测量的综合性指标 ,疾病负担的研究随之产生。不同时期研究疾病负担的思路和使用的方法、指标有所不同 ,主要经历了以下四个阶段 [1] 。　　第一阶段是 1 982年以前 ,单纯…