Objective To analyze the methodological quality of clinical practice guideline mentioned “evidence-based” in China. Methods We selected clinical guidelines developed based on evidence issued by the Chinese Medical Association in 2010-2012, and meanwhile, we conducted additional search for guidelines on clinical major diseases. Then, we selected literature according to the inclusion and exclusion criteria and evaluated the included guidelines according to 8 items relevant to methodological rigor which were selected from the Appraisal of Guidelines for Research and Evaluation (AGREE II). If the guidelines comply with the item, we recorded 1 point, otherwise 0 point. Results a) Among twenty-two included guidelines, 13 were originated and 9 were updated once every 3 to 5 years. b) Diseases covered stroke, diabetes, chronic hepatitis B, hypertension, pediatric nutrition, etc. c) The number of guideline references were 10 to 218, of which, nine guidelines cited 24 Cochrane systematic reviews (CDSRs), accounted for 2.62% (24/916). Among them, the acute ischemic stroke guideline cited the most (7 CDSRs). d) The number of experts involved in guidelines development was 2 to 95 and guidelines pages were 4 to 150. e) The guidelines’ quality generally scored 4 to 7, most of which described the process of guidelines development. The grades of recommendation were consistent with the levels of evidence. But most of the included guidelines did not clearly described literature research methods, peer reviewer, and update procedures. Conclusion There is a growing trend that clinical guidelines are developed based on evidence in China. However, the quality of reporting and the methodological rigor of guidelines need further improvement. The citation rates of Cochrane systematic reviews in these guidelines were relatively low. We suggest that guideline recommendations should be consistent with the levels of evidence and adapt to local conditions, and relevant support policies for guideline implementation in practice. In future, attention should be paid to the aspects of guideline development methods, reporting standard, guideline accessibility, and standard training for relevant personnel.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
Objects To retrospectively analyze the accepted abstracts by the Cochrane Colloquiums in recent 5 years, so as to learn the advances and development trend for next stage in evidence-based medicine field. MethodsAbstracts accepted by the 19th to 23rd Cochrane Colloquiums were collected, and relevant information was extracted. Then, a descriptive analysis was conducted. Outcomes A total of 2088 abstracts were accepted in recent five Cochrane Colloquiums. Europe contributed the most abstracts, in the top 10 contribution countries, five countries were located in Europe. Colleges/Universities were the major contributing institutes, McMaster University of Canada (165, 7.90%) and Lanzhou University of China (118, 5.65%) were the top two contributing institutions. The number of authors of most accepted abstracts were 3 to 5(1011, 48.42%). The top three topics focused by these abstracts were evidence (417, 19.97%), methodology (412, 19.73%) and risk of bias (220, 10.54%). ConclusionsEuropean countries are major contributing countries of abstracts of the Cochrane Colloquium, and colleges/universities are the major contributing institutions. Retrieval and methodology are research hot in recent 5 years. Attention should be paid to breakthrough progress in methodology in future.
Objective ① To document the way in which allocation concealment is described and coded for studies included in Cochrane Reviews.②To feed back any gaps or miscodings to individual review groups.③ To suggest changes and expansions to advice on how to code and describe allocation concealment methods.Methods The coding and description of methods of allocation concealment for studies included in all 1 596 reviews on issue 1, 2003 of The Cochrane Library are being extracted.So far results are available for 10.8% (173/1 596) of reviews containing 1 844 studies, from 10 Collaborative Review Groups (CRGs).Discrepancies, and inconsistencies with the Cochrane Reviewers’ Handbook, are being documented and analysed.Results The current coding of the adequacy of allocation concealment in studies included in Cochrane reviews is not likely to be very accurate.This is due to failure to describe methods of allocation concealment (38.6% of the sample of 1 844 studies) as well as miscoding (at least an additional 9.2%).The most common method for studies coded A was some variation of envelope use (133/675-19.7% of all A codes). The most common "method" for studies coded B was method unclear or not described in the report of the study (426/665, 64% of all B codes).Conclusions Since adequate allocation concealment is so important in protecting against bias in randomised controlled trials, it needs to be accurately coded and described.We need to improve how this is done for studies included in Cochrane Reviews.Since over half the studies coded as D were likely to have been where reviewers omitted to enter a code, the default should be changed from D to "code not supplied".Structural changes to RevMan are suggested-ideally the addition of a separate new study quality assessment table with fixed headings as well as the facility to enter free text.Suggestions for improving coding in particular reviews will be fed back to CRGs in the next stages of this project.Suggestions for additions to the Cochrane Reviewers’ Handbook are also made.
In 1993 the Cochrane Collaboration, an international non-profit organization aiming at producing, updating and disseminating systematic reviews, was founded. Several years later, in 1999, the Chinese Cochrane centre opened in Chengdu, to provide support to (1) Chinese researchers willing to produce reviews and (2) politicians and practitioners willing to start using the results in daily practice. We searched PubMed and the database of the Chinese Cochrane Centre to retrieve data on the overall number of articles and reviews produced in the Chinese language for the period 1990 to 2006. Although the number of reviews increased substantially since the year 2000, the percentage of reviews in the overall number of articles indexed in PubMed remains modest.
Chris Silagy is the Chair of The Cochrane Collaboration between 1996 and 1998, and the founder as well as the first Director of the Australasian Cochrane Centre. He helped to establish the Chinese Cochrane Centre. He has made great contributions to the establishment and development of The Cochrane Collaboration to which he devoted his whole life. Though he died at the early age of 41, his optimism, great energy and b responsibility have left deep impression and inspiration to every one around him.
Objective To evaluate the safety and efficacy of intermittent pneumatic compression in prevention of deep venous thrombosis after major orthopedic operation. Methods We searched MEDLINE (1966 to January 2008), The Cochrane Library (Issue 2, 2008), CBM (1996 to January 2008), CNKI (1998 to January 2008), VIP (1998 to January 2008), and retrieved clinical controlled trials (CCTs) or randomized controlled trials (RCTs) in which IPC was used as an intervention to prevent DVT, and all the trials were published in English or Chinese. The methodological quality of the included studies was assessed according to the standard of Cochrane systematic review. RevMan 4.2 software was used for meta-analysis. Results Seven RCTs and 1 CCT were included. Their methodological quality was poor. The results of Meta–analyses showed: (1) The incidence of DVT in the IPC group was lower than that in the control group (RR=0.20, 95%CI 0.11 to 0.35, Plt;0.000 01); (2) There was no difference in the incidence of DVT between the IPC group and the LMWH group (RR=0.70, 95%CI 0.28 to 1.74, P=0.44); (3) The incidence of DVT in the IPC plus LMWH group was lower than that in the LMWH-alone group (RR=0.23, 95%CI 0.10 to 0.52, P=0.000 4). Furthermore, the incidence of DVT in the IPC plus LMWH group was lower than that in the GCS plus LMWH group (Plt;0.000 1). No severe adverse reaction of IPC in DVT prevention was reported. Conclusion IPC shows an effective tendency in DVT prevention, but because of the low quality and the small sample of the included studies, this conclusion needs to be verified by protocols of more samples and high quality.
Background Tongxinluo capsule is a new drug for cardio- cerebral vascular diseases on the national essential drug list of China, and the second-class award of National Science and Technology Development of China, 2001. Objective This review aims to assess the effect (harms and benefits) of Tongxinluo capsule for unstable angina. Search strategy electronic searchs The Cochrane Heart Review Group specialised trials register,The Cochrane Controlled Trials Register, published in the latest issue of the Cochrane Library, MEDLINE, EMBASE, CBM, Chinese Cochrane Centre Controlled Trials Register, Current Controlled Trials (www. controlled-trials. com), The National Research Register Handsearchs We will search 83 journals of Chinese traditional medicine. Inclusion riteria We will include randomised controlled trials of Tonxinluo capsule versus placebo or other current phamarcotherapy or other Chinese medicinal herbs in the participants with unstable angina pectoris. Studies will report mortality (sudden death from acute myocardial infarction), severity of angina pectoris, frequency of acute attack angina, ECG improvement, rate of dosage reducing or taking frequency of nitroglycerine and symptom improvement, etc. Data analysis Data will be included in a meta-analysis if they are available, of sufficient quality and sufficiently similar.
Background Hepatitis B virus infection is a serious health problem worldwide. Traditional Chinese medicinal herbs have been widely used to treat chronic liver diseases, and many controlled trials have been done to investigate their efficacy. Objectives To assess the efficacy and safety of traditional Chinese medicinal herbs for chronic hepatitis B infection. Search strategy Searches were applied to the following electronic databases: the CHBG Trials Register, the Cochrane Complementary Medicine Field Trials-Register, the Cochrane Library, MEDLINE, EMBASE and BIOSIS. Five Chinese journals and conference proceedings were handsearched. No language restriction was used. Selection criteria Randomized or quasi-randomized trials with at least three months follow-up. Thais of Chinese medicinal herbs (single or compound) compared with placebo, no intervention, general non-specific treatment or interferon treatment were included. Trials of Chinese medicinal herbs plus interferon versus interferon alone were also included. Trials could be double-blind, single-blind or not blinded. Data collection and analysis Data were extracted independently by two reviewers. The methodological quality of trials was evaluated using the Jadad-scale plus allocation concealment. Intention-to-treat analyses were performed. Main Resuits Nine randomized trials, including 936 patients, met the inclusion criteria. Methodological quality was considered adequate in only one trial. There was a significant funnel plot asymmetry (regression coefficient= 3.37, standard error 1.40, P=0.047). Ten different medicinal herbs were tested in the nine trials. Compared to non-specific treatment or placebo, Fuzheng Jiedu Tang (compound of herbs) showed significantly positive effects on clearance of serum HBsAg, HBeAg, and HBV DNA; Polyporus umbellatus, polysaccharide on serum HBeAg and HBV DNA; Phyllanthus amarus on serum HBeAg. Phyllanthus compound and kurorinone showed no significant effect on clearance of serum HBeAg and HBV DNA and on alanine aminotransferase normalization compared to interferon treatment. There were no significant effects of the other examined herbs. Reviewer’s conclusions Some Chinese medicinal herbs may work in chronic hepatitis B. However, the evidence too weak to recommend any single herb. Rigorously designed, randomized, double-blind, placebo-controlled trials are required.