When prioritizing clinical questions in the development of the clinical practice guidelines, clinical questions with high recognition and low variability, or high score and less disagreement among experts were often prioritized, while questions with high recognition but high variability were excluded. By this approach, clinical questions with practical value but also showed high variability due to different causes were not accepted as priorities. There were some methodological and clinical limitations by doing so. By summarizing the causes and connotations of expert opinion variability in terms of clinical experience, expertise and values, this paper analyzed the advantages of the variability quantification application, and proposed corresponding methodological recommendations, so as to provide references for guideline developers in the priority selection of clinical questions.
Since the concept of core outcome set (COS) was introduced into clinical trials of traditional Chinese medicine (TCM), researchers have paid much more attention to develop COS for specific diseases. Although researchers believe that the characteristics of TCM, such as syndromes, should be considered in the COS of TCM, it was insufficiently addressed. In addition, the naming of TCM syndromes has not been standardized, and the classification and diagnostic criteria for specific diseases have been inconsistent. Thus, it is difficult to include TCM syndromes in the COS. Different diseases may show similar TCM syndromes which makes research difficult. Based on previous studies, this paper provided methods of developing core TCM syndromes set according to the model of combination of disease and syndrome and the model of syndrome dominating disease to provide references for future researches.
This study comprehensively reviews the theoretical foundations, historical development, practical applications, and potential challenges of network meta-analysis of diagnostic test accuracy (DTA-NMA). DTA-NMA, as a method for evaluating and comparing the accuracy of different diagnostic tests, demonstrates its unique value in improving diagnostic accuracy and optimizing treatment strategies by integrating direct and indirect evidence, providing crucial support for clinical decision-making. However, despite significant progress in methodology and practice, DTA-NMA still faces multiple challenges in implementation, including enhancing research transparency, integrating diverse evidence, accurately assessing bias risks, presenting and interpreting results, and evaluating evidence quality. In the future, further refinement of reporting standards and evidence grading specific to DTA-NMA research will be crucial for the development of this field, facilitating evidence-based efficient medical decision-making and ultimately improving patient outcomes. This study aims to provide scholars conducting DTA-NMA research with reflection and insights to promote the steady development of this field.
Objective To evaluate the quality of Chinese literatures on the methodology of D-dimer diagnostic test. Method We searched CNKI (1994 to 2006) and CBM (1978 to 2006) for articles involving the diagnostic tests of D-dimer for coagulation disorders. Result A total of 63 relevant articles were retrieved and 7 were included in our review. Only one of these provided useful data on two two table for the evaluation of diagnostic accuracy. Conclusions Few studies on the diagnostic tests of D-dimer have been performed and publ ished in China, all of poor quality. Further studies should focus on clinical diagnostic sensitivity and specificity, so as to provide more valuable information for readers.
This article mainly introduced the purpose and scope relating to the 11 Cochrane methods groups for Cochrane systematic reviews and encourage more people to contribute to the research on methodology.
To introduce the definition, applicable scenarios, methodology and examples of mixed methods systematic reviews, aiming to promote the application of mixed methods in China and to help clinical decision-makers to select appropriate qualitative results from systematic reviews to guide clinical practice.
Objective To systematically review the requirements of patient participation in clinical practice guidelines (CPGs) in Chinese and foreign guideline development manuals. Methods Thirty-six authoritative society websites and guideline databases and 5 commonly used databases were searched online. Relevant information on patients’ participation in the guideline manuals was collected, summarized, and analyzed. Results A total of 37 manuals (33 foreign and 4 Chinese) were included. The requirements for the number of patients, the right to speak, status equality, and the right to vote in the guideline development manual accounted for 35.1%, 13.5%, 8.1%, and 5.4%, respectively. The requirements for participants’ mode of participation were not mentioned in the guideline development manuals from 2000 to 2010. There were 6 (16.2%) in 2011–2015 and 12 (32.4%) in 2016–2022. The comprehensive guidelines for multiple disease types accounted for 35.7%, 28.6%, and 57.1%, respectively, in terms of requirements for participants’ knowledge or experience, management of specialized personnel, and training support. The specific guidelines for a certain type of disease or drug accounted for 21.7%, 4.3%, and 17.4%, respectively; fifteen (40.5%) guideline development manuals mentioned the specific collection forms of patients’ values and preferences in guideline development. Conclusion Given changes to medical models and the emphasis on patients’ rights and interests, an increasing number of manuals have proposed requirements that consider the expression of patients’ values and preferences in manual development, and the dimensions of manual development are constantly enriched. However, manuals outlining the requirements of patient participation are still not comprehensive and can continue to improve.
ObjectiveTo evaluate the quality of randomized controlled trials (RCTs) of Chinese medicine (TCM) formulated granules published in core journals in China. MethodsComputerized searches were conducted in CNKI, VIP, WanFang Data and CBM databases. The publicly published RCTs of TCM formulated granules were collected, with sources from Peking University Core, CSSCI and EI. The following information was extracted: including title, the first author, the journals name, type of disease, year of publication, and source of drug. The included studies were evaluated using the CONSORT extension for CHM formulas (CONSORT-CHM formulas 2017), which included 25 items from title, abstract and keywords, introduction, research methods, steps, results, discussion, and other information. ResultsA total of 125 papers were included, which mainly included digestive system diseases (n=25), respiratory system diseases (n=17), and circulatory system diseases (n=17). The results showed that the overall reporting quality of RCTs of TCM formulated granules was poor. After the publication of the CONSORT-CHM formulas 2017, the reporting quality of RCTs of TCM formulated granules had no significant changes, while some items were still reported with poor quality. For example, 42.2% of RCTs did not adequately report how to generate allocation sequence, 93.3% of RCTs did not adequately report allocation concealment, and 62.2% of RCTs did not adequately report how to solve the missing data. ConclusionThe quality of RCTs reports on TCM formula granules published in Chinese journals still needs to be improved. It is recommended that researchers, journals and reviewers attach importance to the application of CONSORT-CHM formula throughout the whole process of paper writing. In the future, more scientific and detailed requirements should be put forward for trial design and reporting standards in line with the characteristics of clinical trials of TCM formula granules.
ObjectiveTo analyze the reporting and methodological quality of tranexamic acid meta-analyses published in Chinese journals. MethodsThe CNKI, WanFang Data, and CBM databases were electronically searched for meta-analyses of tranexamic acid from inception to August 12th, 2021. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 and PRISMA 2009 to assess the methodological and reporting quality of publications. ResultsA total of 68 meta-analyses were included. The identified meta-analyses required improvement for items 2, 3, 4, 7, 8, 10, 12, 15, and 16 in the AMSTAR 2, and items 2, 5, 8, 12, 15, 17, 22, 24, and 27 in the PRISMA 2009 assessments, respectively. The methodological and reporting quality scores were positively correlated (rs=0.36, P=0.002). Linear regression analysis identified the mentioning of PRISMA and funding support as the independent factors potentially affecting the reporting quality score (P<0.05). ConclusionsBoth the methodological and reporting quality of the tranexamic acid meta-analyses published in Chinese journals require improvement.
ObjectivesTo provide an overview of whether the clinical decision support system (CDSS) was effective in reducing medication error and improving medication safety and to assess the quality of available scientific evidence.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect systematic reviews (SRs) on application of clinical decision support system in the medication error and safety from January, 1996 to November, 2018. Two reviewers independently screened literature, extracted data and then evaluated methodological quality of included SRs by using AMSTAR tool.g AMSTAR tool.ResultsA total of 20 SRs including 256 980 healthcare practitioners and 1 683 675 patients were included. Specifically, 16 studies demonstrated moderate quality and 4 demonstrated high quality. 19 SRs evaluated multiple process of care outcome: 9 were sufficient evidence, 6 were limited evidence, and 7 were insufficient evidence which proved that CDSS had a positive effect on process outcome. 13 SRs evaluated reported patient outcomes: 1 with sufficient evidence, 3 with limited evidence, and 9 without sufficient evidence.ConclusionsCDSS reduces medication error by inconsistently improving process of care measures and seldom improving patient outcomes. Larger samples and longer-term studies are required to ensure a larger and more reliable evidence base on the effects of CDSS intervention on patient outcomes.