Objective To survey and analyze the quality assessment of the included studies in the Overviews of reviews (Overviews), so as to provide methodology references for Overviews authors. Methods A computerized search was performed for collecting Overviews in The Cochrane Library (Issue 1, 2010), PubMed, EMBASE, and CBM, and the search time ended by December, 2009. Then the relevant data, such as assessment standard etc, were extracted, and the staple standards were analyzed. Results A total of 43 typical Overviews were included. Thirty-two (74.4%) of them assessed the methodology quality of the included systematic reviews with different standards, including OQAQ (34.9%/15), AMSTAR (9.1%/3), Checklist from DARE (4.6%/2), Assendelft scale (4.6%/2), Effective Public Health Practice Project standards (2.3%/1), self-formulated standards (14.0%/ 6), syntaxic standards (2.3%/1), and other standards (4.6%/2). Ten Overviews (23.6%) assessed the quality of evidence, including eight (18.6%) applied the GRADE system. Only 7 studies (16.3%) assessed the quality of evidence and applied the GRADE system as well. Conclusion The quality assessment in Overviews includes the assessment of both methodological quality and evidence quality. But most Overviews do not assess comprehensively. The methodological quality standards applied in current Overviews are numerous and no standard is acknowledged. Yet, the OQAQ and AMSTAR are applied widely and recommended because they are comprehensive and easy to be conducted. It suggests that Overviews authors should choose appropriate methodological quality assessment standards according to concrete conditions. The GRADE system is much more comprehensive and systematic than other systems, so it is recommended that Overviews authors should apply GRADE to assess the quality of evidence in their studies in order to make the study results more comprehensive and easier for clinical application.
National Center for Medical Service Administration of National Health and Family Planning Commission of China was established at the beginning of 2015. It is mainly in charge of developing and managing standards of medical technology and organizing their implementation, and giving technical guidance and consulting for evaluation of medical institutions. The foundation of the center fills in the blank of lacking central administrative department of the guideline development and evaluation. This paper introduces the definition and the function of clinical practice guideline, and analyzes the current situation, problems and challenges of domestic guidelines, and proposes some potential suggestions on improving the quality of Chinese guidelines from national level for promoting the standardization, scientification and transparency of clinical practice guidelines in China.
Objective To evaluate the methodological and reporting quality of randomized controlled trials involving traditional Chinese medicine in the treatment of cholelithiasis. Methods We searched CNKI (1994 to 2007), CMCC (1994 to 2007), VIP (1989 to 2007), MEDLINE (1966 to April 2007) and The Cochrane Library (Issue 4, 2006). Data from randomized controlled trials (RCTs) and quasi-RCTs were extracted by two reviewers independently. The methodological quality of included trials was assessed by using the quality assessment criteria recommended by The Cochrane Collaboration, and the reporting quality was assessed by using the CONSORT for TCM checklist. Results Seventeen studies including 16 RCTs and one quasi-RCT were included. The methodological and reporting qualities of included studies were generally low. All studies were graded C. The highest score evaluated by the CONSORT for TCM checklist was 18. Conclusion The quality of RCTs and quasi-RCTs involving traditional Chinese medicine for cholelithiasis is generally low, with a high risk of biases. The reporting of these trials is also incomplete, which would affect a reader’s understanding and evaluation of the validity, importance and applicability of the study results. Therefore, new randomized controlled trials of high quality are required to provide reliable evidence.
ObjectiveTo evaluate the methodological quality of systematic reviews and meta-analysis (SRs/MAs) in fields of integrated Chinese-western therapy for non-small cell lung cancer (NSCLC). MethodsSRs/MAs in fields of integrated Chinese-western therapy for NSCLC were searched inPubMed, EMbase, CBM, CNKI, VIP and WanFang Data from inception to July 10th, 2016. We also handsearched relevant journals such as Chin J Evid-based Med and reference of included studies, and tried to find the grey literature for additional studies. Two researchers independently screened literature and extracted data. Then methodological quality of included SRs/MAs were evaluated by AMSTAR scale. ResultsA total of 53 SRs/MAs were included, the highest and lowest scores of methodological quality were 9 and 1, respectively. The average score was 5.98±1.50. Results on the qualities of methodology or evaluation showed that 46 SRs/MAs (88.68%) was rated as moderate and 6 (11.32%) as low． The main problems were found in such areas as preliminary design scheme, literature searching, a list of included and excluded studies, etc.. ConclusionThe methodology of SRs/MAs in fields of integrated Chinese-western therapy for NSCLC have quality problems at different levels, further improvement should be expected.
Objective To evaluate the methodological quality of clinical trials on traditional Chinese medicine (TCM) nursing in recent six years.Methods Such databases as CNKI, VIP, WanFang Data and CBM were searched for collecting clinical trials on TCM nursing published from January 2006 to September 2011, and domestic primary nursing journals were also searched from January 2010 and September 2011. Methodological quality of included studies was assessed using quality assessment criteria of the Cochrane systematic review guideline. Results A total of 854 clinical trials were retrieved, including 706 (82.7%) randomized controlled trials (RCTs), 108 (12.6%) quasi-randomized controlled trials and 40 (4.7%) non-randomized controlled trials. In the methodological quality analysis, the comparability of baseline was mentioned in 784 trials (91.8%), a total of 498 (58.3%) reported definite diagnosis criteria. 178 (20.8%) reported exclusive criteria. 831 studies (97.3%) applied relevant statistical methods properly. However, only 55 trials (6.4%) mentioned the method of randomization sequence. 10 studies (1.2%) described the method of randomiztion assignment. Blinding was mentioned in 22 studies (2.6%). 98 trials (11.5%) did prospective follow-up. 93 trials (10.9%) had safety description. 20 trials (2.3%) reported lost and with drawl cases, but only 2 conducted intention-to-treat analysis. It was hard to determine whether there was selective reporting bias or not because all the studies did not have protocols. Only 21 studies (2.5%) mentioned the lack of outcome indicators which could be the evidence for existing of bias. By annual analysis, there were 81 trials which conformed to at least 2 low risk criteria. 10 trials (12.3%) was published in 2009, 26 trials (32.1%) published in 2010, and 27 trials published by September 2011, indicated an uptrend. Conclusions According to the Cochrane Collaboration’s tool for assessing risk of bias, the overall quality of clinical trials on TCM nursing is low with defects in different degrees, but it rises gradually over years.
Objective We investigated and analyzed past and ongoing welfare programs related to health equity, and the relevant policies, documents, and interventions measures for improving China’s migrant worker population’s accessibility and utilization of tuberculosis (TB) control services in TB control programs. Then we evaluated their impactin order to provide evidence and suggestions for the further TB prevention and treatment. Methods We retrieved published documents about TB prevention and treatment of the migrant worker population dating from 1998 to 2008 from MEDLINE, PubMed, CNKI, CBMdisc CDDB, and VIP electronically. Simultaneously, a series of interviews was conducted with patients who used the programs. Results Totally, 58 documents were retrieved. Of these documents 13 passed eligibility criteria: eight have been published, five have not been published, and only one of them is RCT with B degree for quality of evidence. Secondary document research has suggested that the intervention measures that have been adopted concerning TB in China, including health promotion, providing incentive, patient tracking and supervision management. Although tuberculosis cure rates have improved, the scene interviews show that the majority of TB and suspected cases of patients don’t have enough knowledge on TB prevention and free treatment policies. It is often difficult to track the migrant population. TB detection and treatment still need to be enhanced. Conclusions There it is lack of high-quality documents about good intervention design, so it is difficult to make a objective and fair evaluation to the effects of intervention on the migrant population. In the future, we should carry out large-scale, multicenter, high-quality RCTs specifically for TB controlin the migrant population in order to provide evidencefor making a scientific and feasible intervention project.
Objective To investigate and analyze the past and on-going pro-poor programs related to health equity, and the relevant policies, documents, interventions measures, etc. to improve the China prisoners’ accessibility and utilization of tuberculosis (TB) control services in TB control programs, then evaluate their impacts and influences to provide evidences and suggestions for the further work of TB prevention and treatment. Methods Retrieve published documents about TB prevention and treatment of transient population dating from 1998 to 2008 from MEDLINE, PubMed, CNKI, CBMdisc CDDB and VIP with computers. Simultaneously, a series of interviews was conducted after we got the agreement of the interview people by using non-probability statistics methods. Results A total of 23 documents were retrieved, and they were consonant with the criteria, among which 8 were published and 5 were policy documents. The study on the second document showed the measures that presently applied on TB patients among prisoners in China: find patients through surveys, inspect every prisons and patients going to visit doctors with symptoms; concerning differences between various groups of prisoners, the measure of “classify and instruction, enroll together and treat” was applied; carry out health education in the prisons and so on. After the implement of various measures, the knowledge awareness, discovery rate, accomplishment ratio, cure rate and so on were all improved. The results of the qualitative interviews showed: the TB patients and the doubts among prisoners could be well gotten together and isolated to receive DOTS; doctors were able to receive trainings on TB treatment and take appointment with certificate. Conclusion According to the results of qualitative interviews, the published and the secondary documents, it could be seen that DOTS are well implemented with remarkable effects.
Objective To evaluate the accuracy and quality of diagnostic test of Electrochemiluminescence immunoassay (ECLIA) in detecting A-fetal protein (AFP) for the diagnosis of liver cancer in Chinese patients. Methods We searched Chinese Biological Medicine Database (CBM, 1978 to 2005) and China National Knowledge Infrastructure (CNKI, 1994 to 2005). Diagnostic tests of ECLIA in detecting AFP for the diagnosis of liver cancer were included. Data were extracted, and the quality of included studies was evaluated according to the six criteria of diagnostic tests. Results Forty-eight studies were identified, but only 6 were included and none mentioned the indices about the accuracy. Conclusion The number of studies of ECLIA in detecting AFP for the diagnosis of liver caner is few and the quality is poor. We cannot draw the conclusion that ECLIA is better for sensitivity and specificity.
ObjectivesTo assess the methodological quality of Chinese clinical practice guidelines (CPGs) for respiratory diseases published in 2017, so as to provide evidence for developing and updating CPGs of this field in the future.MethodsWanFang Data, CNKI, VIP, CBM databases, Medlive and other related websites were electronically searched to collect Chinese CPGs for respiratory diseases published from January 2017 to December 2017. Four reviewers independently evaluated the quality of eligible guidelines by using Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument.ResultsA total of 37 guidelines were included. The mean scores of the six AGREE Ⅱ domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, editorial independence) were 59.3%, 25.1%, 10.8%, 59.1%, 25.8%, and 7.3%, respectively. Only 1 guideline (2.7%) was recommended for clinical use, and 2 guidelines (5.4%) were recommended with modification.ConclusionsThe CPGs for respiratory diseases published in China in 2017 have higher quality than CPGs published prior to 2017, however great discrepancies exist when comparing with international guidelines of average level. More attention should be paid on the rigorousness of methodology and the practicality of content in the future development of CPGs.
AMSTAR (Assessment of Multiple Systematic Reviews) is currently developed as a measurement tool with extensive application to assess the methodological quality of systematic review/meta-analysis. It has good reliability, validity, and responsibility, and has been widely applied. This paper introduces AMSTAR to researchers and users in China, in view of development procedure, assessment items, and application status.