Objective To evaluate the quality of Chinese clinical practice guidelines published in domestic medical journals in 2011. Methods The following 4 Chinese databases including WanFang Data, VIP, CNKI and CBM were searched from January 2011 to December 2011. The quality of included guidelines was assessed by using AGREE II. Results A total of 75 guidelines published in 2011 were included. Among them, 10 guidelines (13%) stated the conflict of interest, 10 guidelines (13%) mentioned evidence-based developing, 5 guidelines (7%) performed evidence grading system, 8 guidelines (11%) performed recommendation strength grading system, and 4 guidelines (5%) performed both evidence and recommendation strength grading systems. The ratio of the 6 domains’ scores of AGREEⅡ were as follows: scope and purpose (18%), stakeholder involvement (11%), rigour of development (8%), clarity of presentation (34%), applicability (5%), and editorial independence (14%). Conclusion Compared with the guidelines published before, the guidelines of 2011 have a higher quality and some of them are progressively standardized in developing methodology.
Objective Through assessing the quality of systematic reviews/meta-analyses conducted by hospital pharmacists in China, to learn relevant situations and to promote the development and application of evidence-based pharmacy in hospital. Methods The following databases such as CBM, CNKI, Wanfang Database, VIP, CMCI, The Cochrane Library, EMbase and PubMed were searched from the establishment date to April 15th, 2011, to collect all published systematic reviews/meta-analyses conducted by hospital pharmacists in China. Two reviewers independently extracted the published information according to the inclusive and exclusive criteria, and assessed the methodology and reporting quality of the included literatures with OQAQ and PRISMA. Disagreements were discussed or resolved by the third reviewer. Data analysis was conducted by using SPSS17.0 software. Results Two hundred and sixteen Chinese literatures (including 40 on traditional Chinese medicine), and 15 English literatures were identified. The number of literatures has increased rapidly since 2008. Beijing and Sichuan were the top 2 districts in the number of literatures. All of the included literatures were published in 62 magazines sponsored by 87 hospitals, such as China Pharmacy, and Chinese Journey of Evidence-Based Medicine. The total downloads of Chinese literatures were 14346, and the total citations of all literatures were 154. The methodology and reporting quality of the randomized controlled trials (RCTs) involved in 220 systematic reviews/meta-analyses literatures were assessed, which showed the highest and lowest scores of methodological quality were 6 and 3, respectively, and the average score was 4.27±0.55. The highest and lowest scores of reporting quality were 22.5 and 9, respectively, and the average score was 16.49±2.98. Conclusion Although the evidence-based pharmacy in hospital begins late in China, it develops rapidly, and offers lots of evidence to policy decision, guidelines and rational drug use. However, there is still room for improvement of the methodology and reporting quality in future reviews.
Objective To assess the methodology and report quality of Chinese systematic reviews/ meta-analyses on prevention and control of six major diseases in public health. Methods Chinese literatures of systematic reviews/ meta-analyses on prevention and control of six major diseases, including cancer, cerebrovascular disease, cardiovascular disease, hepatitis B, tuberculosis, and AIDS were searched in CQVIP, WANFANG Database, CNKI, and the Chinese Biomedical Literature Database from the establishment date to June, 2010. Two researchers independently screened and evaluated the data, disagreements were resolved by discussion. Methodology quality and report quality of included reviews were evaluated by OQAQ scale and PRISMA scale. Result Of the 139 literatures included in the analysis, 32 were systematic reviews while 107 were meta-analyses. The highest and lowest scores of methodology quality were 6.5 and 1.5 respectively. The average score was 4.66±0.92 and no literature could meet all nine items. The main problems were insufficient in literatures resource, bias in data selection, lack of rigorous quality assessment for included original studies and so on. The average score of report quality were 15.28±2.91 and the main problems were incomplete report in abstract, data collection and analysis methods, bias control, conclusion and so on. Conclusion Both of the methodology quality and report quality of included literatures have problems in different levels, which require to be further improved.
Objective To assess the quality of diagnostic studies on detecting the tuberculosis antibody to diagnose tuberculosis.Methods CBM (1978 to 2006) and VIP (1994 to 2006) were searched; any author-claimed diagnostic studies which used the dot immunogold filtration assay (DIGFA) to detect the tuberculosis antibody and to diagnose tuberculosis were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was used to assess the quality of included diagnostic studies by two reviewers independently.Results Thirty-eight papers were included and assessed. We found that most of the quality items were not met with QUADAS. Most papers adopted the retrospective diagnostic case-control design. Thirty-one papers did not describe the selection criteria clearly, 18 did not describe whether all the included patients were verified by using a reference standard of diagnosis, 36 did not describe whether the index test results were interpreted without knowledge of the results of the reference standard, 37 did not report the uninterpretable/intermediate test results, and 34 did not report the withdrawals from the study.Conclusion There are few high quality studies on using DIGFA to detect tuberculosis antibody to diagnose tuberculosis.
Objective To evaluate the quality of undergraduate medical education so as to provide useful and effective feedback information for medical schools and to extend GMER (Global Minimum Essential Requirements in Medical Education) standard. Methods Through questionnaires, 205 resident doctors self-evaluated their abilities or qualities based on GMER standard. The unconditioned logistic regression model was used for data analysis. Results Graduates from undergraduate medical programs mastered the abilities or qualities required in 4 GMER domains i.e. “professional values, attitudes, behaviors and ethics”, “clinical skills”, “communication skills”, and “scientific foundation of medicine”. But the abilities or qualities required in “information management”, “population health and health systems” as well as “critical thinking and research” domains have not been obtained. The main factors that affected the evaluation results were corresponding training to the essentials, learner’s attitude, teaching models and teaching hours. Conclusion Educational sectors should adjust curriculum design so as to help medical students master the abilities required in the 3 domains stated above. Medical schools should conduct some educational research to formulate the most beneficial teaching methods, and import advanced ones to raise the quality of medical education in China.
Objective To evaluate the quality of diagnostic studies on detecting anti-cyclic citrullonated peptide antibody to diagnose rheumatoid arthritis. Methods We searched PubMed, EMbase, The Cochrane Library, and CBM to collect studies on using anti-cyclic citrullonated peptide antibody to diagnose rheumatoid arthritis. QUADAS items were used to evaluate the quality of included studies. Results A total of 195 studies were included. Sixty-nine were English studies and 126 were Chinese studies. All studies had good descriptions of the spectrum of patients and little potential for partial verification bias, differential verification bias, and incorporation bias. However, most studies were prone to disease progression bias, review bias, and clinical review bias. One study did not explain the intermediate test results, and another did not report part of the test results. The overall quality of English studies was better than that of Chinese studies. Conclusion The potential bias of the included studies mainly resulted from the absence of blinding when interpreting the test results. The reporting quality of the included studies was poor.
Objective To assess the quality reports on acupuncture in the treatment of postherpetic neuralgia. Methods MEDLINE, CBM, CMCC and CNKI from 1994 to 2006 were searched electronically. Handsearching was also done. The retrieved articles were assessed in terms of several factors, including the type of clinical research, methodology, diagnostic criteria, inclusion/exclusion criteria, effectiveness measurements, calculation of sample size, follow-up, etc. Results Among the 109 included articles, only 6 were true randomized controlled trials. There were 17 quasi-randomized controlled trials, 13 non-randomized concurrent controlled trials, 1 case-control study and 63 narrative studies. 29 of the reports clearly described the diagnostic criteria, 14 mentioned the inclusion/exclusion criteria, 79 reported the effectiveness measurements, none mentioned the calculation of sample size, 24 reported the follow-up outcomes, and only 1 mentioned adverse reactions. Conclusion More prospective, multicenter, large-scale, high-quality randomised trials are needed, and recommendations should also be made for future evaluations of methodological quality.
Objective To investigate the preparing procedures for the larger chemically acellular nerve allografts (CANA) and to establish an evaluation criteria and the preparation method.Methods The sciatic nerves ofthe dogs were exposed by a muscle-splitting incision and were isolated free of the underlying fascia. The 50-mm-long segments of the nerve were made. The proximal and distal ends of the nerve segments were labelled and stabilized by pinning the ends to a thin plastic support, and then they were treated according to the following decellularization processes: The nerve segments were rinsed with the distilled water for 9h, transferred in a 3% Triton-100 solution for 12 h, soaked in 7% sodium deoxycholate for 12 h, and washed in the distilled water for 6 h. All the decellularization steps were performed at room temperature. The nerve segments were divided into 5 subgroups. In Group Ⅰ, Group Ⅱ and Group Ⅲ, the nerve segments were decellularized for 2, 3 and 4 times, respectively. In Group Ⅳ and Group Ⅴ, the two ends of the nerve segments were ligated with a silk line and were decellularized for 2 and 3 times, respectively. Each nerve segment was subdivided into 5 portions from the proximal end to the distal end. The degrees of decellularization, activity of Laminin, degrees of demyelination, and integrity of the nerve fiber tube were observed under microscope and were assessed by a scoring system. Results In all the groups the activity of Laminin was present and the degrees of decellularization were complete. As for the demyelination of the nerve segments, the myelin sheath in Groups Ⅰ, Ⅱ and Ⅲ was partially preserved, but it completely disappeared in Groups Ⅳ and Ⅴ. The structure of the nerve fiber tube in Groups Ⅰ and Ⅳ was almost normal. The total score for the degrees of decellularization, demyelination, and structural integrity was the lowest in Group Ⅳ but the quality was the best. Conclusion The degrees of demyelination are not parallel to the times of decellularization processes. In the quality control of CANA, we should consider the following 4 factors: activity of Laminin, degrees of decellularization, demyelination, and structural integrity. For the larger CANA,ligation of the two ends of the nerve segments during the decellularization procedure may be a better method of ensuring the quality of the decellularization.
Objective To survey and analyze the quality assessment of the included studies in the Overviews of reviews (Overviews), so as to provide methodology references for Overviews authors. Methods A computerized search was performed for collecting Overviews in The Cochrane Library (Issue 1, 2010), PubMed, EMBASE, and CBM, and the search time ended by December, 2009. Then the relevant data, such as assessment standard etc, were extracted, and the staple standards were analyzed. Results A total of 43 typical Overviews were included. Thirty-two (74.4%) of them assessed the methodology quality of the included systematic reviews with different standards, including OQAQ (34.9%/15), AMSTAR (9.1%/3), Checklist from DARE (4.6%/2), Assendelft scale (4.6%/2), Effective Public Health Practice Project standards (2.3%/1), self-formulated standards (14.0%/ 6), syntaxic standards (2.3%/1), and other standards (4.6%/2). Ten Overviews (23.6%) assessed the quality of evidence, including eight (18.6%) applied the GRADE system. Only 7 studies (16.3%) assessed the quality of evidence and applied the GRADE system as well. Conclusion The quality assessment in Overviews includes the assessment of both methodological quality and evidence quality. But most Overviews do not assess comprehensively. The methodological quality standards applied in current Overviews are numerous and no standard is acknowledged. Yet, the OQAQ and AMSTAR are applied widely and recommended because they are comprehensive and easy to be conducted. It suggests that Overviews authors should choose appropriate methodological quality assessment standards according to concrete conditions. The GRADE system is much more comprehensive and systematic than other systems, so it is recommended that Overviews authors should apply GRADE to assess the quality of evidence in their studies in order to make the study results more comprehensive and easier for clinical application.