scholarly journals Assessing the Quality of the First Batch of Evidence-Based Clinical Practice Guidelines in Traditional Chinese Medicine

2011 ◽  
Vol 31 (4) ◽  
pp. 376-381 ◽  
Author(s):  
WEN-ya YU ◽  
Jian-long XU ◽  
Nan-nan SHI ◽  
Li-ying WANG ◽  
Xue-jie HAN ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based

scholarly journals Enhanced Evidence-Based Chinese Medicine Clinical Practice Guidelines in Hong Kong: A Study Protocol for Three Common Diseases

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Nannan Shi ◽  
Linda L. D. Zhong ◽  
XueJie Han ◽  
Tat Chi Ziea ◽  
Bacon Ng ◽  
...  
Keyword(s):  
Hong Kong ◽  
Clinical Practice ◽  
Chinese Medicine ◽  
Text Mining ◽  
Cerebral Infarction ◽  
Study Protocol ◽  
Chronic Gastritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based

We presented a study protocol of developing Chinese medicine clinical practice guidelines for three common diseases in Hong Kong, including insomnia, chronic gastritis, and cerebral infarction. This research project will be conducted in three phases. First phase is the preparation stage which consists of the establishment of steering committee and panel. Second phase involves 6 steps, which are searching and identifying evidence, text mining process, Delphi survey, synthesizing of data, consensus conference, and drafting guidelines. In this phase, text mining technique, evidence-based method, and formal consensus method are combined to get consolidated supporting data as the source of CM CPGs. The final phase comprised external reviews, dissemination, and updating. The outputs from this project will provide three CM CPGs for insomnia, chronic gastritis, and cerebral infarction for Hong Kong local use.

scholarly journals Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

2020 ◽  
Author(s):  
Agustín Ciapponi ◽  
Tapia-López Elena ◽  
Virgilio Sacha ◽  
Ariel Bardach
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cochrane Library ◽  
Evidence Based ◽  
Agree Ii ◽  
Quality Of Evidence ◽  
Moderate Quality

Abstract Background Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence and strength of recommendations according to the GRADE methodology. Results We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last five years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain ‘applicability’ obtained the worst score: 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. ‘Guidelines’ applicability’ and ‘monitoring’ were the most deficient domains. Only half of the EB-CPGs were updated in the past five years. Conclusions We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines’ quality.

scholarly journals Editorial Vol.3(1)

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 3
Author(s):  
Anisur Rahman
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Medical Practice ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Evidence Based ◽  
Practice Parameters

Bangladesh is a country with a large population. The health care needs of this huge population are met by a plethora of health care workers many of whom are not even trained formally for this work (traditional healers). Even in those who are trained in formal medicine we find doctors with various academic background and training. There is an amulgation of medical degrees which is not seen anywhere else in the world. As a result the diagnostic and clinical approach to patient varies widely. This setup denies the patient the standard of care that he or she deserves. In this context clinical practice guidelines can play a major role in standard patient care. Clinical practice guidelines are systematically developed to assist practitioners’ and patients' decisions about appropriate health care for specific clinical circumstances. Many terms have been developed including practice guidelines, practice standards, practice parameters, practice policies, protocols, algorithms, and critical paths, but the collective purpose is the same - reduction in unnecessary variability of care. Historically it started in USA, from attempts to monitor quality of care and cost of care. Experimental Medical Review Organizations were started in USA in 1971 by the National Center for Health Services Research and Development, which provided grants to assess quality of care. Legislation was signed into law as part of the Omnibus Reconciliation Act of 1989, creating the Agency for Health Care Policy and Research (AHCPR) [1]. A guideline is a stepwise evaluation of a clinical diagnosis or management strategy that requires observations to be made, decisions to be considered, and actions to be taken. Processes used during development of guidelines include informal and formal consensus methods, evidence-based methods, and explicit methods. Informal consensus method leads to poor quality and have been largely abandoned. Formal consensus development, based on the delphi technique is a stepwise process leading to recommendations that reflect the extent of agreement amongst individuals. This technique is limited in that it does not rely on explicit linkage between recommendation and the quality of the evidence reviewed. Evidence based methods have emerged with specific rules defined to link recommendations and supporting evidence [2]. Basic Steps in Guideline Development [3], [4] have been standardized by various international bodies and may be implemented in our country with a few adjustments. There are still methodological problems that have been identified. These include the needs to further define consistent definitions, to avoid publication bias, to maintain sensitivity to evolution in scientific understanding, and to develop criteria for validity of clinical research methods. Economic factors affecting guideline development also need to be avoided and include specialist interests, payer interests, and the need to disclose economic self interests [5]. A final problem is the challenge of disseminating already written guidelines to physicians and presents a formidable task unto itself and adds to the large burden of new data and information practitioners already have available. Guidelines should, therefore, be viewed as broad templates to assist physicians or patients in various clinical circumstances [6]. Clinical practice guideline is becoming an important determinant of how medicine and surgery is practiced in Western societies. It is time that this strategy is also introduced in Bangladesh to reduce variability in care, improve quality, measure outcomes, and reduces costs. It is expected of such institution as BCPS, and the professional bodies like Society of Surgeons and Association of Physicians of Bangladesh to initiate and implement such clinical guidelines.Prof. Dr. Anisur RahmanSenior Consultant & CoordinatorDepartment of General and Laparoscopic SurgeryApollo Hospitals DhakaReferencesGosfield A. Clinical practice guidelines and the law: applications and implications. In: Health Law Handbook. New York: Clark Boardman Callaghan; 1994:67-99.Roper WL, Winkenwerder W, Hackharth GM, Krakauer H. Effectiveness in health care: an initiative to evaluate and improve medical practice. NEJM. 1988; 319:1197-1202.American Medical Association. Office of Quality Assurance. Attributes to Guide the Development of Practice Parameters. Chicago.Schoenbaum SC, Sundwall DN, Reqman D. Using Clinical Practice Guidelines to Evaluate Quality of Care. AHCPR 95-0045, 1995;1&2.Ayres JD. The Use and Abuse of Medical Practice Guidelines. J Legal Med. 1994; 15:421-443.Tunis SR, Hayward R, Wilson MC. Internists’ attitudes about clinical practice guidelines. Ann Intern Med. 1994; 120:956-963.DOI: 10.3329/pulse.v3i1.6542Pulse Vol.3(1) July 2009 p.3

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