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肺源性心脏病临床实践指南方法学和报告质量评价

贾俊海,张元元,刘爱萍,狄宝山,王建成,尚轶,唐艳,田金徽   

  1. 甘肃省康复中心医院,兰州大学基础医学院,甘肃卫生职业学院,甘肃省人民医院,甘肃省人民医院,兰州大学第二医院,兰州市第二人民医院,兰州大学循证医学中心
  • 收稿日期:2018-11-27 修回日期:2018-11-27 出版日期:2018-12-25
  • 基金资助:
    兰州市人才创新创业项目 (项目编号:2015-RC-65201525;项目名称:亚高原地区急诊疾病谱相关危险因素的研究及急救优化策略);甘肃软科学专项项目(项目编号:1604ZCRA011;项目名称:城市流浪人员医疗救助模式对策研究);甘肃省人民医院院内科研基金项目(项目编号:17GSSY2-7;项目名称:甘肃省“医养结合”模式构建及应用研究)

The Methodology and Reporting Quality Assessment of the Clinical Practice Guidelines for Pulmonary Heart Disease

JIA Junhai,ZHANG Yuanyuan,LIU Aiping,DI Baoshan,WANG Jiancheng,SHANG Yi,TANG Yan and TIAN Jinhui   

  1. Gansu Provincial Hospital Rehabilitation Center,Gansu Lanzhou,兰州大学基础医学院,甘肃卫生职业学院,甘肃省人民医院,甘肃省人民医院,兰州大学第二医院,兰州市第二人民医院,兰州大学循证医学中心
  • Received:2018-11-27 Revised:2018-11-27 Online:2018-12-25

摘要: 目的:运用指南研究与评价Ⅱ(AGREEⅡ)工具及RIGHT清单评价和分析肺源性心脏病(以下简称肺心病)临床实践指南的方法学和报告质量,为未来肺心病指南的制定与报告提供参考和借鉴。方法:系统检索PubMed、EMBASE、CBM、CNKI和Wanfang 5个数据库,以及GIN、SIGN、NGC、NICE 4个指南数据库,并补充检索医脉通网站。两名研究人员独立筛选文献、提取数据,遇到分歧讨论解决或咨询第三方。运用AGREEⅡ工具和RIGHT清单评价纳入指南的方法学和报告质量,并计算组内相关系数(ICC)值评价两名研究人员运用AGREEⅡ工具评价指南的一致性。结果:共纳入4篇指南。纳入指南发表于2013—2016年,主要来自4个国家,其中英国最多(2篇,50%)。1篇(25%)指南发表于期刊,3篇(75%)来自NICE指南数据库。ICC值为0.873[95%CI(0.851,0.909),P=0.004]。纳入指南6个领域得分依次为范围和目的(27.1%,SD=6.2%)、参与人员(50.7%,SD=5.7%)、制定严谨性(44.9%,SD=3.4%)、表达明晰性(78.5%,SD=15.4%)、应用性(27.1%,SD=8.2%)、编辑独立性(57.3%,SD=30.9%)。纳入指南的平均得分为12.6(SD=1.2),范围为11~13.5分。报告充分比例大于50%的条目共5条。结论:25%的肺心病指南于近两年发表,指南主要来自于欧洲。与国际平均水平相比,肺心病指南除了“范围和目的”领域外,在其余领域的得分均较高。纳入指南RIGHT的平均得分较低,且40%的条目上未报告的比例大于50%。

Abstract: Objective:To evaluate and analyze the methodology and reporting quality of clinical practice guidelines for pulmonary heart disease by the AGREE Ⅱ instrument and RIGHT checklist, in order to give reference for the formulation and report of guidelines for pulmonary heart disease in the future. Methods:We systematically searched five general databases, including PubMed, EMBASE, Chinese Biomedical Literature Database (CBM), Wanfang database, and China National Knowledge Infrastructure (CNKI), and four guidelines databases, namely, Guidelines International Network(GIN), Scottish Intercollegiate Guidelines Network(SIGN), National Guideline Clearinghouse(NGC)and National Institute for Health and Clinical Excellence(NICE).Additionally, we also searched the website of Yimaitong.Two independent reviewers screened and extracted data.When meeting the disagreement, we solved it by discussion or consultation with a third reviewer-Two reviewers evaluated methodology and reporting quality of the included guidelines by AGREE Ⅱinstrument and RIGHT checklist.The consistency was assessed by the ICC value. Results: Four guidelines were included. These guidelines were published from 2013 to 2016, and mainly from four countries, particularly UK (two guidelines, 50.0%).Three guidelines (75.0%) were from the website of guidelines, and one guideline (25.0%) was from journals.The consistency between two assessors was high, ICC value was 0.873[95%CI(0.851, 0.909), P=0.004]. The scores of six domains were scope and purpose (27.1%, SD=6.2%), stakeholder and involvement(50.7%, SD=5.7%), rigor of development(44.9%, SD=3.4%), clarity of presentation(78.5%, SD=15.4%), applicability(27.1%, SD=8.2%), and editorial independence(57.3%, SD=30.9%), respectively.The average score of reporting quality of guidelines was 12.6(SD=1.2), which the total score of each guideline ranged from 11 to 13.5. There were five items in which more than 50% guidelines were evaluated as adequately reporting. Conclusion:25% guidelines for pulmonary heart disease are published from 2016 to 2017, and from the European countries.By comparing with the average scores of the guidelines worldwide, the scores of guidelines for pulmonary heart disease are apparently higher in most domains, apart from “scope and purpose”.At the same time, the RIGHT scores are relative low. Particularly, there are more than 50% quidelines reported nonthing in more than 40% items.