The number of clinical guidelines developed and published in different countries is increasing worldwide. Too many guidelines do not remain in regular use, even though the aim is to implement them in clinical practice. The scientific validity and reliability of the guidelines need to be reviewed. Here is a case presented to show how to optimally use the evidence-based guideline to improve clinical decision making.
This article discussed the development and current situation about both national and international diagnostic practice guidelines, as well as the role of evidence based medicine and systematic reviews in the development of such guidelines. Authors also analyzed the opportunities and challenges developers faced, and the methods and processes of development. Finally, authors proposed several strategic suggestions about how to improve the quality of diagnostic practice guideline in China.
Patient values and preferences is one of the elements of evidence-based medicine research, which is also an important part that should be considered in the development of evidence-based guidelines in the present and future. However, the research in this field in China has just begun. This article gives a brief introduction of its concepts, methods, influence factors based on the international researches of patient values and preferences and a brief description of the development in China, in order to provide references for the development of evidence-based guidelines based on the consideration of patient values and preferences in the future.
Objective To investigate and analyze the status of clinical guidelines of children in China, so as to regulate the development of children’s evidence-based clinical guidelines and provide recommendations for children’s clinical guidelines. Methods Names of guidelines, year and institution of publication, methodology of development and reference number were descriptively analyzed. Years of publication and diseases of guidelines were analyzed with statistical graphs. AGREE instrument was used to evaluate the evidence-based guidelines of children. Results a) Of 91 clinical guidelines of children, 62 were translations. Of 29 guidelines ourselves, nine were traditional Chinese medicine guidelines and five (17%) were evidence-based guidelines; b) Guideline on Rational Use of Antibiotics in Acute Respiratory Infections (Probation), the first guideline of children, was published in 1999. Guidelines of children was not published until 2005. Then, the number of guidelines was increasing each year and reached a peak in 2008. Of 13 guidelines in 2008, seven were traditional Chinese medicine guidelines. Guidelines on respiratory diseases were 14 ranked as the top; c) Guidelines on congenital deformity and chromosomal abnormalities, tumor, circulatory system disease, blood disease and western guideline on communicable disease were not formulated in China; and d) Average scores on six domain of five evidence-based guidelines were 84.4%, 37.5%, 74.3%, 90.0%, 22.2%, 46.6%, respectively. Guide on Diagnosis and Treatment of Children Aged 0 to 5 with Acute Fever of Unknown Etiology was bly recommended, Guide on Management of Children with Community-Acquired Pneumonia, Evidence-Based Guide on Diagnosis and Treatment of Children with Common Kidney Disease, Guide on Nutrition Support of Newborn, Guide on Diagnosis and Treatment of Children with Chronic Cough were recommended. Conclusion Clinical guidelines of children in China begin late, develop slowly and are lack of update. A standard on development of guidelines is needed. The government should increase the fund of development, implementation and promotion of guidelines. Recommendations for high-quality guidelines should be included in procedure of medical quality assurance. Compliance of guidelines should be provided by organization which formulatesd the guideline, so as to promote the application of high-quality guidelines.
ObjectiveTo systematically review quality of evidence-based pneumocystosis guidelines for children, compare the differences and similarities among recommendations, and to provide references for clinical application. MethodsDatabases such as TRIP, PubMed, CNKI, VIP, WanFang Data, CBM, U.S National Guideline Clearinghouse (NGC), and Guidelines International Network (GIN) were searched to collect evidence-based guidelines on medication therapy for children with pneumocystosis. Methodological quality of included guidelines was evaluated according to the AGREE Ⅲ instrument, and the differences and similarities among recommendations were compared. ResultsA total of 3 evidence-based guidelines concerning children with pneumocystosis were included, of which, 2 were made by the USA and 1 by international academic organizations. Only 1 guideline was especially suitable for children, while others were for children of different ages and adults. The results of AGREE Ⅲ scoring showed that, among 6 domains which were rated using the AGREE Ⅲ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation" and "editorial independence" were scored more than 60%; while "applicability" was only scored 46%, 25% and 31%. Besides, the grading of evidence and grading of recommendations were different. The medication recommendations of different guidelines were not the same. ConclusionThe quality of 3 guidelines is not high, and the grading of evidence and the strength of recommendation are still needed to be unified. The target population and the recommendations in the guidelines are different.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for children with vitamin D deficiency, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsDatabases such as the TRIP, PubMed, EMbase, CNKI, VIP, WanFang Data, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect EBGs on medication therapy for children with vitamin D deficiency. The methodological quality of the guideline was evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 EBGs were included. Among them, 3 guidelines were developed by America, 1 by Europe, 1 by France, 1 by China, 1 by Poland, 1 by Canadian and 1 guideline was by Australia and New Zealand. Seven guidelines were developed specially for children, while others were for people of different ages. According to the AGREE Ⅱ instrument, only "Scope and purpose" and "clarity and presentation" were scored more than 60%. The recommendations of different guidelines were of large different. ConclusionThe quality of included guidelines concerning children with vitamin D deficiency is vary. Although only the America 2011 guideline is of high quality, the strength of recommendation is not high. Thus, the development of national guidelines is urgently needed.
A well-conducted evidence-based guideline not only considers the efficiency and the cost of the recommended intervention, but also the acceptability and feasibility of the intervention during implementation. Systematic reviews of qualitative research aim to provide qualitative evidence such as the acceptability and feasibility of the intervention. In developing evidence-based guidelines, qualitative evidence helps to:(1) Define the scope of guideline; (2) Assess the acceptability of interventions; (3) Assess the feasibility of interventions; (4) Identify considerations when implementing guidelines. Systematic reviews provide the fundamental evidence required to develop robust and trustworthy guidelines. The CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach aims to grade the evidence from systematic reviews of qualitative research. After critically and scientifically appraising by CERQual, the acceptance and feasibility of an intervention are given different grading, which is the critical process of developing evidence-based guidelines. This paper will demonstrate the value of systematic reviews of qualitative research in developing evidence-based guidelines and how to implement recommendations from qualitative evidence.
Every country has its own clinical guideline to standardize medical care, and China is developing guidehnes too. Viewing the guidehne＇s usage in the world over many years, we find that it hasn＇t achieved good effect. The development of evidence-based medicine brings a primal change to guideline development. The evidence-based clinical guidehnes are arising in the world. We summarized the principle of developing evidence-based guideline according to the experience of Scotland to provide reference for domestic peers.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for neonatal bacterial meningitis, and compare differences and similarities of the drugs recommended, in order to provide references for clinical application. MethodsDatabases such as the TRIP, PubMed, CNKI, VIP, WanFang, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect evidence-based guidelines on medication therapy for neonatal bacterial meningitis. Methodological quality of included studies was assessed according to the AGREE Ⅱ instrument, and the differences and similarities among recommendations were compared. ResultsA total of 4 EBGs were included. Among them, one guideline was developed by the America and three guidelines were by the UK. Only one guideline was developed specially for neonates, while the rest were for neonates and children of different ages. According to the AGREE Ⅱ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation", "applicability" and "editorial independence" were scored more than 60%. The recommendations of different guidelines were basically the same, only with conflicts in some areas. ConclusionAlthough most guidelines concerning neonatal bacterial meningitis are of high quality, grading levels of evidence and strength of recommendation should be unified.
In this article, three research cases are introduced to show the rationale of analysis of papers cited in evidence-based guidelines and the implementation steps. The ultimate goal of medical research is to promote health; evidence-based guidelines are of most importance to medical practice, which can be directly used in clinical practice and health prevention. One of the ways in which research can influence practice is through its contribution to being references of guidelines, and it’s a new way to evaluate biomedical research’s “payback” on health.