Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Menopause Unit, Monash Health, Melbourne, Victoria, Australia.
Maturitas. 2019 Dec;130:21-31. doi: 10.1016/j.maturitas.2019.09.009. Epub 2019 Sep 22.
Clinical practice guidelines (CPGs) are systematically developed statements that guide clinicians to provide appropriate healthcare. The aims of this study were: 1) to systematically evaluate the quality of menopause management CPGs; 2) to identify menopause topics included in the CPGs; 3) to summarize the recommendations regarding either early menopause (EM) or premature ovarian insufficiency (POI) provided by high-scoring CPGs; and 4) to develop EM/POI management algorithms.
A systematic search for CPGs published between 2012 and 2017 was conducted using Medline, Embase, All EBM, CPG databases and medical websites. Appraisal was conducted by 4 independent reviewers using the Appraisal of Guidelines for Research & Evaluation II instrument (AGREE II). Inter-rater reliability was calculated using the intraclass correlation coefficient. Recommendations regarding EM/POI were extracted from high-scoring CPGs and translated into a management algorithm, which was refined on the basis of feedback from expert clinicians.
The systematic search yielded 22 CPGs for review. Only 2 were assessed as high quality, with 10 average and 10 considered low quality. Scope and purpose (73% ± 15%) and clarity of presentation (78% ± 15%) achieved the highest mean scores, while applicability scored the lowest (23% ± 18%). Inter-rater agreement was 0.74 (good) to 0.91 (very good). The most comprehensive CPGs were those developed by the National Institute for Health and Care Excellence (NICE), the International Menopause Society (IMS) and the European Menopause and Andropause Society (EMAS).
Most menopause CPGs are poor to average quality and there is variation between them in EM/POI management recommendations. EM/POI management algorithms were developed from high-scoring CPGs.
临床实践指南（CPGs）是系统制定的指导临床医生提供适当医疗保健的声明。本研究的目的是：1）系统评估绝经管理 CPG 的质量；2）确定 CPG 中包含的绝经主题；3）总结高分 CPG 提供的关于早期绝经（EM）或卵巢早衰（POI）的建议；4）制定 EM/POI 管理算法。
使用 Medline、Embase、All EBM、CPG 数据库和医学网站，对 2012 年至 2017 年期间发表的 CPG 进行了系统搜索。使用评估指南研究与评估 II 工具（AGREE II）由 4 名独立评审员进行评估。使用组内相关系数计算了组间可靠性。从高分 CPG 中提取了关于 EM/POI 的建议，并将其翻译成管理算法，根据专家临床医生的反馈进行了改进。
系统搜索产生了 22 个 CPG 进行审查。只有 2 个被评为高质量，10 个为中等质量，10 个为低质量。范围和目的（73%±15%）和演示文稿的清晰度（78%±15%）得分最高，而适用性得分最低（23%±18%）。组间一致性为 0.74（良好）至 0.91（非常好）。最全面的 CPG 是由英国国家健康与保健卓越研究所（NICE）、国际绝经学会（IMS）和欧洲绝经和雄激素缺乏学会（EMAS）制定的。
大多数绝经 CPG 的质量较差，在 EM/POI 管理建议方面存在差异。从高分 CPG 中开发了 EM/POI 管理算法。
