目的 探讨胰头部肿块型慢性胰腺炎的诊断要点与个体化术式的选择原则。方法 回顾性分析2000年4月至2011年9月期间我院收治的10例胰头部肿块型慢性胰腺炎患者的临床资料。结果 本组平均发病年龄47.3岁，平均病程69.1d，平均总胆红素99.4µmol/L，CA19-9 55～78U/ml。10例B超检查示肝内胆管及胆总管扩张，5例CT检查报告胰头部占位性病变伴主胰管不规则扩张或钙化灶，2例MRCP检查诊断胆总管下段占位。3例术中多点穿刺快速活检后行胆胰管引流术，7例术前误诊为胰头癌或壶腹癌均行胰十二指肠切除，术后出现并发症8例，死亡1例，9例平均随访44.2个月无复发和癌变。结论 把握发病年龄、病程、波动性黄疸等临床特征和CA19-9水平及CT、MRCP等影像检查要点是胰头部肿块型慢性胰腺炎与胰头癌鉴别诊断的关键，用个体化术式合理实施胰十二指肠切除、胆胰管内外引流术是胰头部肿块型慢性胰腺炎外科处理明智的选择。
ObjectiveTo get known of the application of Preferred Items of Systematic Review and Meta Analysis (PRISMA). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), CBM, WanFang Data and CNKI, to collect relevant literature about the application of PRISMA during 2009-2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and then bibliometric analysis was performed using Excel software. ResultsWe finally included 175 papers, including 26 conference abstracts and 149 full texts. The results of bibliometric analysis of full texts showed that, they were published in 118 journals, and PRISMA official website announced that 176 journals endorsed the application of PRISMA. According to study type, there were 111 systematic reviews and meta-analyses (SRs/MAs) for development and reporting, 20 overviews of SRs for reporting quality assessments, 7 versions of PRISMA interpretation, and 11 articles of other kinds. In 131 SRs/MAs as well as overviews, the studies about western medicine accounted for 77.8%, followed by public health (8.4%), and traditional Chinese medicine (4.6%). ConclusionThe application of PRISMA statement is still at the first phase and mainly confined to the field of western medicine, which needs more attention and understanding. Thus, it's necessary to interpret and disseminate the PRISMA statement.
In response to the public health emergency and other urgent needs, World Health Organization (WHO) developed the concept and methodology of rapid advice guidelines (RAGs) in 2006. Compared with the standard guideline, striving to minimize the risk of bias, the RAG shortens the time to 1-3 months from more than 2 years. This study introduces the background, definition, application condition and performing methods of RAGs, and uses an example to clarify it, thus to provide a reference for the guideline development of public health emergency and other urgent need in China.
The financial conflict of interests is drawing a wide attention, while several problems such as the unclarity of definition and blurred boundary of classification exist when it comes to the nonfinancial conflict of interests. Taking clinical practice guidelines as the example, this study introduce how nonfinancial conflict of interests happen, their classifications and impact based on present situation of relevant studies.
Adapting the existing guidelines in the context of specific regions can improve the efficiency of guidelines development, and reduce cost and time for developing guidelines. ADOLOPMENT is a methodological tool for guidelines adaptation, which was developed by the GRADE Working Group based on the standardized international guidelines making process. With ADOLOPMENT, developers can effectively use existing guidelines and evidence, avoid duplication of the evidence evaluation, and record the process from evidence to recommendations, which will ensure the transparency of adaptation, help users to understand the process, and improve the acceptability and credibility of guideline adaptation. This paper aims to introduce the ADOLOPMENT and its application.
The focus of health equity is to enable the public to have fair access to health services and achieve satisfactory health outcomes. With research developments, guideline developers increasingly pay more attention to the fairness in the practice guidelines and have carried out exploration and practice in the relevant guidelines. The GRADE working group has begun to investigate how to use GRADE to assess health equity in practice guidelines since 2014. In 2017, the series of methodological guidelines of health equity in guideline development was officially published. It proposed 5 approaches to evaluate health equity and pointed out current methodological challenges of applying GRADE to assess health equity. This paper aims to introduce the GRADE equity guidelines, so as to provide a reference for Chinese researchers in their practice.
Surgical management of osteoarthritis of the knee: evidence based guideline contains 38 recommendations pertaining to the preoperative, perioperative, and postoperative care of patients with knee osteoarthritis (KOA) who are considering surgical treatment. Compared with the domestic consensus on diagnosis and treatment for KOA, this clinical practice guideline (CPG) prepared by the American Academy of Orthopedic Surgeons (AAOS) has some advantages in terms of methodology selection and recommendation. Therefore, it is necessary for us to interpret this CPG to speed up the understanding and dissemination of the CPG. The ultimate aims are to: ① strengthen the standardization and understanding of surgical treatment of KOA; ② enhance the understanding of clinicians for this CPG in treating KOA; ③ speed up the development of guideline development methodologies in China; ④ provide methodological guidance for the development of CPG based on the current situation in China.
The approaches of rating the quality of evidence of systematic reviews of diagnostic accuracy tests are different from systematic reviews of interventional studies. This article systematically introduces the application of GRADE in systematic reviews of diagnostic accuracy tests by a case interpretation and analysis. In this article we present rating workflow in systematic reviews of diagnostic accuracy tests and introduce how to use the GDT website to display the rating results, and interpret the conclusion of systematic reviews based on GRADE results.