Clinical efficacy evaluation is important for the development of traditional Chinese medicine (TCM). In view of the existing accumulation and current situation of the TCM clinical efficacy evaluation, based on the international perspective, and taking the rational and objective evaluation of TCM clinical efficacy and safety as the foundation, in order to enhance TCM evidence level to support clinical decision-making and promote TCM industry and TCM internationalization development, the State Administration of TCM entrusted China Academy of Chinese Medical Sciences to establish China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM). CCEBTCM is expected to optimize the allocation of evidence-based research resources in TCM field to further integrate advantages of evidence-based TCM research teams, promote consensus on evidence-based TCM standards, share evidence-based TCM data or information and lead cultural exchanges between Chinese and overseas. In this way, the status and influence of TCM in the world will be enhanced so that it can better serve global health.
ObjectiveTo systematically evaluate the methodological quality of traditional Chinese medicine (TCM) guidelines and expert consensuses for the diagnosis and treatment of coronary heart diseases (CHD).MethodsDatabases including PubMed, CNKI, CBM, WanFang Data and the official websites of the China Association of Traditional Chinese Medicine, and the Chinese Association of Integrated Traditional and Western Medicine were electronically searched to collect guidelines (or expert consensus) of TCM for CHD from January 1st, 2010 to January 1st, 2021. Methodological evaluation of the included guidelines was conducted by 3 researchers independently using the AGREE Ⅱ instrument.ResultsA total of 16 guidelines were included. The AGREE Ⅱ scores for each domain were: clarity and presentation (63.89%), followed by scope and purpose (55.90%), stakeholder involvement (42.13%), the rigor of development (41.42%), editorial independence (32.12%), and applicability (21.99%). Nine guidelines were rated as level B (recommended after being revised), and 7 were rated as level C (not recommended).ConclusionsGuidelines and expert consensuses of TCM for CHD provide a standard for clinical practice, however, the methodological quality remains to be improved. It is suggested that future guidelines be formulated in accordance with international standards and using the methods of evidence-based medicine to improve the quality of guidelines further and promote international acceptability.
ObjectiveTo analyze the causal relationship between obstructive sleep apnea (OSA) with its typical symptoms (daytime sleepiness and snoring) and cardiovascular diseases (hypertension, coronary heart disease, myocardial infarction, heart failure) by using Mendelian randomization. MethodsWe used the instrumental variables (IV) in the FINNGen database and the UK Biobank to perform two-sample Mendelian randomization (TSMR) analysis. The results of random-effects inverse variance weighting method (IVW) were the main results. MR-Egger method was used for pleiotropic analysis and sensitivity analysis was performed by the leave-one-out method to verify the reliability of the data. ResultsOSA could lead to hypertension (IVW β=0.043, 95%CI 0.012 to 0.074, P=0.006) and heart failure (IVW β=0.234, 95%CI 0.015 to 0.452, P=0.036). Daytime sleepiness also had a pathogenic effect on heart failure (IVW β=1.139, 95%CI 0.271 to 2.006, P=0.010). There was no causal association between OSA and CHD or MI, snoring and the four CVDs. There was no causal association between daytime sleepiness and hypertension, CHD or MI.ConclusionOSA and daytime sleepiness have pathogenic effects on hypertension and heart failure, with heart failure being the most affected.
ObjectiveTo evaluate the methodological quality of clinical practice guidelines and expert consensus of chronic heart failure domestically and abroad.MethodsPubMed, EMbase, SinoMed, CNKI, WanFang Data, and VIP databases, and related websites were searched to collect guidelines and expert consensus on chronic heart failure published from January 1st, 2011 to December 31st, 2020. Four reviewers evaluated the methodological quality of the guidelines and expert consensus with the AGREE Ⅱ tool after the consistency evaluation training.ResultsA total of 17 studies were included (consisting of 11 English and 6 Chinese studies). The recommended levels were B level (recommend after modification) for 10 studies and C level (not recommended) for 7 studies. The AGREE Ⅱ standardized mean scores for various fields were 69.61% (scope and purpose), 34.20% (stakeholder involvement), 33.13% (rigor of development), 84.53% (clarity and presentation), 42.40% (applicability), and 37.09% (editorial independence). The methodological quality of English guidelines was generally high (level B for 10 and level C for 1), while all scores of Chinese guidelines or consensus in the 6 fields were mostly lower than the average (level C for 6).ConclusionsThe guidelines for the diagnosis and treatment of chronic heart failure requires further improvement in terms of stakeholder involvement and rigor of development. It should develop standards and methods to improve the quality for Chinese guidelines and expert consensus to better serve clinical practice.
Rapid, living evidence-based points, as a new model promoting the rapid translation of evidence, aim to integrate the current best evidence, clinical status, public/patient preferences and values, and provide concise and practical guidance rapidly to important questions concerned in clinical medicine and public health. This paper introduces the methodological framework for the development of "Rapid, Living Evidence-Based Points" from 4 aspects: initiation and planning, evidence search and review, development, update, publication and dissemination of evidence-based points, in order to provide a reference for domestic scholars in developing rapid, living evidence-based points.