ObjectiveTo systematically review the efficacy and safety of pediatric tuina in the treatment of children with acute diarrhea.MethodsCNKI, VIP, WanFang Data, CBM, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the treatment of children acute diarrhea with tuina from inception to November 20th, 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 464 children were included. The results of meta-analysis showed that compared with Western medicine, tuina for children with acute diarrhea could increase the cure rate (RR=1.43, 95%CI 1.26 to 1.63, P<0.001), shorten the time for the frequency of diarrhea to return to normal (MD=?0.86, 95%CI ?1.05 to ?0.66, P<0.001) and the time for stool traits to return to normal (MD=?1.07, 95%CI ?1.15 to ?0.99, P<0.001). There was no statistically significant difference in the incidence of adverse reactions between tuina and Western medicine (RR=0.25, 95%CI 0.03 to 2.23, P=0.22).ConclusionsCurrent evidence shows that tuina has a superior effect on treating children with acute diarrhea, the incidence of adverse reactions is not increased. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
As an essential tool for clinical practice, the clinical practice guidelines have been continuously completed and the quality of the guidelines has been improved. However, there are still issues in updating the guidelines and recommendations. This article introduces the living guideline formulation method, through dynamic monitoring, timely inclusion of new evidence, and living update of recommendations, etc. to improve the timeliness of clinical guidelines. The article aims to provide methodological references for the timely transformation of evidence and the update of guidelines.
Evidence mapping is a new type of comprehensive evidence research method that systematically collects, evaluates, and synthesizes existing evidence to clarify research status and gaps, thereby promoting scientific research and decision-making. After nearly 20 years of development, the methodology of evidence mapping has been continuously improved, and has gained wide attention and recognition from the international community. China has paid much attention to evidence mapping at an early stage, but there are relatively few theoretical and practical researches, and the concept definition is inconsistent. This paper introduces the methodology of evidence mapping production and reporting for researchers to use for reference, with a view to further promoting the research and development of evidence mapping in China.
ObjectiveTo systematically review the efficacy and safety of different tyrosine kinase inhibitors (TKIs) in the treatment of chronic myelocytic leukemia (CML).MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of nilotinib, dasatinib, flumatinib and imatinib for CML from inception to August, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; network meta-analysis was then performed using Stata 15.0 software and R 3.4.0 software.ResultsA total of 8 RCTs involving 2 775 patients were included. Compared with other TKIs, flumatinib had higher 3-month early molecular response and 1-year progression free survival, and the incidence of serious side effects was relatively low. Major molecular response and complete cytogenetic response were significantly superior to imatinib, and had the same or similar effects to other second-generation TKIs.ConclusionsCurrent evidence shows that flumartinib in the treatment of CML is obviously superior to imatinib, has the same or similar effect with other second generation TKIs. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
The primary advantage of network meta-analysis is the capability to quantify and compare different interventions for the same diseases and rank their benefits or harms according to a certain health outcome. The inclusion of a variety of interventions has increased the complexity of the conclusions drawing from a network meta-analysis, and based on the ranking results alone may lead to misleading conclusions. At present, there are no accepted standards for the conclusion drawing from a network meta-analysis. In November 2020, based on the evidence certainty results of network meta-analysis, the GRADE (Grades of Recommendations Assessment, Development and Evaluation) working group proposed two approaches to draw conclusions from a network meta-analysis: the partially contextualised framework and the minimally contextualised framework. This paper aimed to introduce principles and procedures of the minimal contextualised framework through a specific example to provide guidance for the network meta-analysis authors in China to present and interpret the results using minimally contextualised framework.
The outline of the "Healthy China 2030" states that medical institutions should serve as the primary purchasing agents for medicines and medical consumables, and joints purchasing should be encouraged. Since its establishment, the National Healthcare Security Administration has conducted five batches of national centralized procurement of high-value medical consumables, forming a nationwide collaborative framework involving national, provincial (including inter-provincial alliances), and local municipalities (including local municipal alliances). This study explains the current development status of the centralized procurement of medical consumables in representative countries, and explores the role of research evidence, such as health technology assessment (HTA), in the centralized procurement of medical consumables in China. Looking ahead, various forms of research evidence, such as HTA, will contribute to the dynamic adjustment of the catalogue for the collection and procurement of medical consumables, and the construction of a comprehensive evaluation index system for the clinical use of medical consumables, as well as the integration of evidence-based and artificial intelligence technology for the whole life-cycle management of medical consumables, will inject new impetus into the management of collection and procurement and innovation.
At present, the network meta-analysis has been rapidly developed and widely used, and it has the characteristic of quantifying and comparing the relative advantages of two or more different interventions for a single health outcome. However, comparison of multiple interventions has increased the complexity of drawing conclusions from network meta-analysis, and ignorance of the certainty of evidence has also led to misleading conclusions. Recently, the GRADE (grading of recommendations assessment, development and evaluation) working group proposed two approaches for obtaining conclusions from a network meta-analysis of interventions, namely, the partially contextualised framework and the minimally contextualised framework. When using partially contextualised framework, authors should establish ranges of magnitudes of effect that represent a trivial to no effect, minimal but important effect, moderate effect, and large effect. The guiding principles of this framework are that interventions should be grouped in categories based on the magnitude of the effect and its benefit or harm; and that when classifying, consider the point estimates, the rankings, and the certainty of the evidence comprehensively to draw conclusions. This article employs a case to describe and explain the principles and four steps of partially contextualised framework to provide guidance for the application of this GRADE approach in the interpretation of results and conclusions drawing from a network meta-analysis.
Unprocessed red meat and processed meat consumption: dietary guideline recommendations from the NutriRECS consortium is based on five high quality systematic reviews that were developed using the nutritional recommendations guideline development process. The guideline develop recommendations primarily focus on participant important health outcomes (such as the incidence of cancer, cardiovascular disease and mortality) related to the consumption of red and processed meats. Based on the estimated average weekly intake of these meats (3 to 4 servings/week) in North America and Western Europe, the panel suggests that adults continue their current unprocessed red meat and processed meat consumption. The present paper interprets the guideline.
In response to the specific requirements of nutrition research, Schwingshackl’s research group developed the NutriGrade grading system, which independently assessed the quality of evidence in randomized controlled trials and cohort studies in nutrition, aiming to summarize the associations or effects between different nutritional factors and outcomes and meet the specific needs of evidence users. It has the advantages of novel classification, quantifiability, independence and pertinence, and it has better consistency, fairness, reliability and feasibility. Well-designed prospective cohort studies are more feasible in the field of nutrition than randomized controlled trials. The grading of the evidence quality for cohort studies included the following eight items: a) risk of bias, study quality, and study limitations; b) precision; c) heterogeneity; d) directness; e) publication bias; f) funding bias; g) effect size; and h) dose-response. Based on the evaluation results of the above items, the evidence quality could be divided into four grades: high (8-10), moderate (<8), low (<6), and very low (<4). The purpose of this paper was to introduce the basic principles, specific contents, and application methods of the NutriGrade grading system for cohort studies and cite examples to provide references for relevant researchers.
As the highest level of evidence in evidence-based medicine, systematic reviews have a profound impact on clinical practice and policy-making. However, challenges remain regarding the methodological rigor and reproducibility of their results. In recent years, replication research on systematic reviews has emerged as a critical approach to ensuring evidence quality, rational allocation of research resources and advancing evidence-based medicine. This article systematically reviews the theoretical foundations and research value of replication studies in systematic reviews, with a focus on their core design principles and implementation process. Key methodological steps are discussed, including assessing the necessity of replication, determining the type of replication, pre-registration, obtaining data and code, conducting independent re-analyses, and evaluating result consistency. Meanwhile, using the childhood deworming program as an illustrative case, we further outline the practical workflow of conducting replication research and demonstrate its importance in confirming the robustness of evidence and strengthening confidence in decision-making. In addition, this study synthesizes the methodological challenges encountered throughout the entire replication process, from literature searching to data analysis, and discusses future directions involving the integration of artificial intelligence, the development of reporting standards such as PRITERS, and the establishment of supportive research infrastructures. Overall, this work aims to provide methodological guidance for the standardized conduct of replication studies and to support the high-quality development of evidence-informed practice.