食管胃静脉曲张出血管理临床实践指南质量评价。
Evaluation of the quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding.
机构信息
aDepartment of Medicine, Research, Capacitation and Management Centre for Evidence-Based Health (CIGES), La Frontera University, Temuco, Chile bIberoamerican Cochrane Centre, Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain cDivision of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas, USA.
出版信息
Eur J Gastroenterol Hepatol. 2014 Apr;26(4):422-31. doi: 10.1097/MEG.0000000000000033.
SETTING
Clinical practice guidelines (CPGs) should provide healthcare practitioners with the best possible evidence. Their quality, however, is often suboptimal. An evaluation of CPGs for the treatment of esophageal or gastric variceal bleeding (VB) has not been performed to date.
AIM
The aim of this study was to identify and evaluate the quality of CPGs for esophageal or gastric VB.
METHODS
We performed a systematic search of the scientific literature published up to July 2012 to identify and select CPGs related to the management of esophageal or gastric VB. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument. Standardized scores were calculated for the six domains of each instrument, and the overall agreement among reviewers was assessed on the basis of the intraclass correlation coefficient.
RESULTS
Of a total of 23 CPGs identified, 10 were selected. Intraobserver agreement was good (overall intraclass correlation coefficient of 0.956, 95% confidence interval 0.958-0.973). The overall quality of the guidelines varied from low to moderate. Stratified by domains, the quality was good to acceptable in three domains: 'scope and purpose' (78.1%, median 82.3, range 46-100); 'clarity and presentation' (87.2%, median 91.6, range 67-98); and 'editorial independence' (64.1%, median 61.1, range 22-94), but with deficiencies in another three: 'rigor of development' (47.6%, range 28-94), 'stakeholder involvement' (47.5%, median 37, range 18-98) and 'applicability' (25.9% median 13.2, range 1-83). In the overall evaluation, two guidelines were considered 'highly recommended', three, 'recommended with modifications', and five, 'not recommended'. There was a significant improvement in quality over time.
CONCLUSION
The overall quality of CPGs for the management of esophageal or gastric VB has improved over time. Although the overall quality was not optimal, two guidelines achieved an excellent rating. A summary of recommendations is provided.
背景
临床实践指南（CPG）应向医疗保健从业者提供尽可能最好的证据。然而，其质量往往并不理想。迄今为止，尚未对治疗食管或胃静脉曲张出血（VB）的 CPG 进行评估。
目的
本研究旨在确定和评估治疗食管或胃 VB 的 CPG 的质量。
方法
我们对截至 2012 年 7 月发表的科学文献进行了系统搜索，以确定和选择与食管或胃 VB 管理相关的 CPG。三名独立评审员使用评估指南、研究和评估 II（AGREE II）工具对合格指南进行评估。为每个工具的六个领域计算了标准化评分，并根据组内相关系数评估了评审员之间的总体一致性。
结果
共确定了 23 项 CPG，其中 10 项被选中。观察者内一致性良好（总体组内相关系数为 0.956，95%置信区间为 0.958-0.973）。指南的总体质量从低到中等不等。按领域分层，在三个领域的质量为良好至可接受：“范围和目的”（78.1%，中位数 82.3，范围 46-100）；“清晰度和表述”（87.2%，中位数 91.6，范围 67-98）；和“编辑独立性”（64.1%，中位数 61.1，范围 22-94），但在另外三个领域存在缺陷：“开发的严谨性”（47.6%，范围 28-94），“利益相关者参与”（47.5%，中位数 37，范围 18-98）和“适用性”（25.9%，中位数 13.2，范围 1-83）。在总体评估中，有两项指南被认为“强烈推荐”，三项被认为“推荐并修改”，五项被认为“不推荐”。指南的质量随着时间的推移有所提高。
结论
治疗食管或胃 VB 的 CPG 的总体质量随着时间的推移有所提高。尽管总体质量并不理想，但有两项指南达到了优秀评级。提供了一份推荐摘要。
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