The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease not only updates aortic valve stenosis, mitral regurgitation, prosthetic valves, infective endocarditis and antithrombotic treatment on the basis of the 2017 guidelines update for valvular heart disease, but also involves aortic valve regurgitation, bicuspid aortic valve, mitral stenosis, tricuspid regurgitation, combined valve disease, pregnancy with valvular disease, valve disease complicated with coronary heart disease, valve disease complicated with non-cardiac surgery and the prospect of comprehensive management of valve disease. It covers a wide range of contents, which are introduced in detail and comprehensively. This paper interprets some highlights and core issues, including the top 10 take-home messages, the severity of valvular heart disease, and the updates in the management of aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, mitral stenosis and mitral regurgitation.
Based on the site visit on the current application and practice of evidence-based medicine in USA, we find the difference between China and USA so as to further promote and plan the development of evidence-based medicine in China.
ObjectivesTo summarize and compare the operative mechanisms of the most representative comprehensive clinical practice guideline (CPG) databases worldwide, so as to provide references for establishing and managing Chinese CPG database.MethodsCPG databases were collected worldwide by discussing with experts in the guideline and database fields. Studies on guideline databases were searched in PubMed and CNKI to further collect CPG databases mentioned in these studies. Representative comprehensive guideline databases were finally selected by consulting relevant guideline experts. The institutions’ names of establishing and managing CPG databases, funding sources, human resources, aims, quality control measures (including CPG inclusion and updating criteria) were extracted and summarized. Databases were divided into government-led, society-led, and enterprise-led models. A descriptive analysis was conducted.ResultsThere were four government-led databases, four society-led databases and merely one enterprise-led database. The institutions of establishing CPG databases were same as the institutions of managing databases in the seven databases. All CPG databases had set up offices, seven of which were located in the capital. Most databases’ funds came from the government. Four databases implemented board management. According to the division of functions, members involved in establishing and managing CPG databases mainly included leaders, expert teams, managerial personnel, secretaries, web developers, and patient representatives. Criteria for inclusion of CPG were relevant to the purpose of establishing databases. Most databases required guidelines that had be updated within three to five years.ConclusionsThis study provides comprehensive information on operative mechanism of different CPG databases which can assist guideline database builders to optimize their operative mechanism.
Objective To systematically review published methodological guidelines for health technology assessment (HTA) at home and abroad. Methods Common electronic databases, guideline databases, international networks of HTA agencies/organizations, representative national HTA networks and official websites of governmental health departments were extensively searched and screened to identify guidelines for conducting or reporting HTA from inception to April 24, 2023. Basic information on guidelines, HTA processes, assessment indicators, reporting checklists and other information was extracted, analyzed and described using a systematic review methodology. Results A total of 41 guidelines were included in this study, published from January 2002 to January 2023; the publishing institutions involved 23 countries/international organizations, and 6 languages; the assessments were mainly for all health technologies (n=23), pharmaceuticals (n=4), diagnostic/testing technologies (n=4), non-pharmaceutical health technologies (n=3), medical devices/equipment (n=3), hospital health technologies (n=2), medical and surgical interventions (n=1), and screening technologies (n=1); the assessment perspectives were mainly health system perspectives (n=16), societal perspectives (n=12), and hospital perspectives (n=3), while the rest did not provide information on the perspectives; 28 guidelines described the detailed HTA assessment process, involving 11 steps; there were 39 guidelines described the assessment domains and related assessment indicators in detail, ranging from 2 to 9 assessment domains and involving 10 first-level assessment indicators; a checklist for HTA reports listed in 10 guidelines, involving 18 report entries; 17 guidelines reported conflicts of interest, mostly no conflicts of interest (n=10), and 3 of the remaining 7 guidelines did not indicate a specific conflict of interest, while 4 guidelines in which possible sources of conflict of interest were indicated. Conclusion The development of HTA has formed a relatively perfect assessment system, but there is a need to unify the criteria for classification of health technologies and reporting checklist, improve the specificity indicators for different types of health technologies, and clarify the assessment perspectives. Combined with the current situation of HTA development in China, contextualized guidelines for HTA implementation and reporting should be formulated to provide scientific information and methodological basis for decision-making on rational allocation of health resources.
ObjectivesTo evaluate the quality of evidence-based guidelines for the treatment of female stress urinary incontinence, so as to provide evidence for clinical stress urinary incontinence management research.MethodsWebsite of the professional society, clinical practice guide website, Yimaitong website, PubMed, CNKI, WanFang Data and VIP databases were electronically searched to collect stress urinary incontinence management related guidelines from January 1st, 2014 to January 1st, 2019. Two reviewers independently screened literature, extracted data and evaluated the quality of included guidelines using Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the characteristics of each guidelines were analyzed.ResultsWe identified totally 8 relevant evidence-based guidelines in this field. The average standardized scores in the 6 domains of AGREE II were 90.74% (scope and purpose), 78.71% (stakeholder involvement), 74.60% (rigor of development), 93.52% (clarity of presentations), 61.81% (applicability), and 91.67% (independence). The overall standardized scores of 8 guidelines were 77.70%, and the total scores were 5.31 (out of 7). For overall quality, 4 of them were grade A and 4 of them were grade B.ConclusionsThe overall quality of evidence-based guidelines for stress urinary incontinence is high, and scores in different fields are vary large. Fields of " stakeholder involvement”, " rigor of development” and " applicability” with lower scores still requires strengthening. The current guidelines for female stress urinary incontinence in China still fails to meet the standards of evidence-based guidelines, so the quality of the guidelines should be improved to improve guide clinical practice.
In order to promote the clinical diagnosis and treatment of obstructive sleep apnea (OSA) in Chinese children, it is urgent to construct evidence-based guidelines. The protocol and a formal version of the “Chinese guideline for Diagnosis and Treatment of Obstructive Sleep Apnea in Children” will be drawn up by referring to the “World Health Organization Guidelines Development Manual”. This protocol mainly introduces development methodology and process of guideline, including the significance, purpose, target population, users, members of the designated group, collection and determination of clinical problems and outcome indicators, evidence acquisition, evaluation and synthesis, the generation of recommendations and so on.
Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common emergencies of the digestive system. With the continuous development of digestive endoscopy technology and widespread use of proton pump inhibitors, the morbidity and mortality of ANVUGIB have declined, but there are still numerous difficulties to be solved in clinical treatment. The International Consensus Group in 2019 updated the international consensus guideline in 2003 and 2010 with new clinical recommendations on fluid resuscitation, risk assessment, pre-endoscopic treatment, endoscopic treatment, drug therapy, and secondary prevention, etc. This paper interprets the update to provide references for the clinical treatment of ANVUGIB.
