Thoughts and suggestions on the application of expert evidence in traditional Chinese medicine in clinical practice guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Yicheng ^1,2,3 , WANG Jianxin ⁴ , SUN Yuanyuan ⁴ , LI Lei ⁵ , WANG Guihua ⁶ , XIA Ruyu ^1,2,3 , LIU Zhihan ^1,2,3 , TAO Liyuan ⁷ , CAO Rui ^1,2,3 , FENG Yuting ^1,2,3 ,  GAO Xuemin ⁸ ,  FEI Yutong ^1,2,3

1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
2. Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
3. Beijing GRADE Center, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
4. Standardization Project Office of China Traditional Chinese Medicine Association, Beijing 100061, P. R. China;
5. Research and Development Committee of Western and Chinese Medicine of China Traditional Chinese Medicine Association, Beijing 100061, P. R. China;
6. China Traditional Chinese Medicine Association, Beijing 100061, P. R. China;
7. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, P. R. China;
8. Beijing University of Chinese Medicine, Beijing 100029, P. R. China;

Corresponding?author：

GAO Xuemin, Email: xuemingao2011@163.com; FEI Yutong, Email: yutong_fei@163.com

Keywords：

Expert evidence; Expert opinion; Expert experience; Traditional Chinese medicine; Clinical practice guideline

DOI：

10.7507/1672-2531.202305124

Video：

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In the process of formulation, traditional Chinese medicine clinical practice guidelines are often faced with the dilemma of lack of evidence. Guidelines development groups tend to make final decisions based on expert experience or expert opinion, but the limitations of cognitive bias reduce the credibility and transparency of the guidelines. By clarifying the difference between the expert experience and expert opinion and expert evidence, the expert evidence of traditional Chinese medicine discipline advantages and necessity, providing the recommendation form link using expert evidence methodology design and implementation details, retaining the empirical characteristics of traditional Chinese medicine and improving the lack of evidence, has certain practical application value.

Citation： GAO Yicheng, WANG Jianxin, SUN Yuanyuan, LI Lei, WANG Guihua, XIA Ruyu, LIU Zhihan, TAO Liyuan, CAO Rui, FENG Yuting, GAO Xuemin, FEI Yutong. Thoughts and suggestions on the application of expert evidence in traditional Chinese medicine in clinical practice guidelines. Chinese Journal of Evidence-Based Medicine, 2023, 23(11): 1360-1364. doi: 10.7507/1672-2531.202305124 Copy

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7.	American Society of Clinical Oncology (ASCO). Methodology manual. 2021.
8.	European Society of Human Reproduction and Embryology. Manual for ESHRE guideline development. 2019.
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10.	Murad MH, Chang SM, Fiordalisi CV, et al. Improving the utility of evidence synthesis for decision makers in the face of insufficient evidence. J Clin Epidemiol, 2021, 135: 170-175.
11.	Legault K, Schunemann H, Hillis C, et al. McMaster RARE-Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome. J Thromb Haemost, 2018, 16(8): 1656-1664.
12.	Pai M, Santesso N, Yeung CH, et al. Methodology for the development of the NHF-McMaster guideline on care models for haemophilia management. Haemophilia, 2016, 22(Suppl 3): 17-22.
13.	Nesrallah GE, Mustafa RA, MacRae J, et al. Canadian Society of Nephrology guidelines for the management of patients with ESRD treated with intensive hemodialysis. Am J Kidney Dis, 2013, 62(1): 187-198.
14.	Schünemann HJ, Zhang Y, Oxman AD, et al. Distinguishing opinion from evidence in guidelines. BMJ, 2019, 366: l4606.
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18.	徐偉超, 李佃貴, 杜艷茹. 基于當代京津冀名老中醫藥專家經驗的慢性萎縮性胃炎病因病機及證素規律研究. 遼寧中醫雜志, 2021, 48(4): 28-31.
19.	《中成藥治療優勢病種臨床應用指南》標準化項目組. 中成藥治療膝骨關節炎臨床應用指南(2020年). 中國中西醫結合雜志, 2021, 41(5): 522-533.
20.	梁葆朱, 趙子葦, 穆俊霞. 全國名老中醫藥專家經驗方臨床研究類文獻常見問題分析. 山西中醫藥大學學報, 2020, 21(2): 83-86.
21.	陳立柱. 中醫專家經驗繼承方法的拓展. 光明中醫, 2015, 4(4): 901-902, 903.
22.	王麗穎. 基于專家經驗和臨床證據的中成藥、西藥合用臨床實踐指南制訂的方法學研究. 中國中醫科學院中醫臨床基礎醫學研究所, 2013.
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24.	蔡德英. 名老中醫專家經驗的撰寫要點. 中國中醫藥信息雜志, 2012, 19(6): 97-97.
25.	Antman EM, Lau J, Kupelnick B, et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA, 1992, 268(2): 240-248.
26.	The Oxford Centre for Evidence-Based Medicine (CEBM). Explanation of the 2011 OCEBM levels of evidence. 2019.
27.	Scottish Intercollegiate Guidelines Network 50: a guideline developer's handbook. 2019.
28.	SUNY Downstate EBM Tutorial. Guide to research methods: the evidence pyramid. 2019.
29.	程勇. 中醫流派傳承發展面臨的問題與思考. 江蘇中醫藥, 2017, 49(2): 69-70.
30.	陳仁壽. 中醫流派研究中存在的問題與思考. 南京中醫藥大學學報(社會科學版), 2016, 17(4): 216-218.
31.	郜巒, 王振國, 張豐聰. 大數據背景下的地域性中醫學術流派研究. 世界科學技術-中醫藥現代化, 2018, 20(1): 32-36.

1. Institute of Medicine. Clinical practice guidelines we can trust. Washington (DC): National Academies Press (US), 2011.
2. 陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022版). 中華醫學雜志, 2022, 102(10): 697-703.
3. National Institute for Health and Care Excellence (NICE). Developing NICE guidelines, the manual. 2020.
4. American Academy of Neurology. Clinical practice guideline process manual. 2017.
5. The American College of Occupational and Environmental Medicine. Practice guidelines methodology. 2017.
6. Minds Guideline Center, Japan Council for Quality Health Care. Minds handbook for clinical practice guideline development. 2021.
7. American Society of Clinical Oncology (ASCO). Methodology manual. 2021.
8. European Society of Human Reproduction and Embryology. Manual for ESHRE guideline development. 2019.
9. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
10. Murad MH, Chang SM, Fiordalisi CV, et al. Improving the utility of evidence synthesis for decision makers in the face of insufficient evidence. J Clin Epidemiol, 2021, 135: 170-175.
11. Legault K, Schunemann H, Hillis C, et al. McMaster RARE-Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome. J Thromb Haemost, 2018, 16(8): 1656-1664.
12. Pai M, Santesso N, Yeung CH, et al. Methodology for the development of the NHF-McMaster guideline on care models for haemophilia management. Haemophilia, 2016, 22(Suppl 3): 17-22.
13. Nesrallah GE, Mustafa RA, MacRae J, et al. Canadian Society of Nephrology guidelines for the management of patients with ESRD treated with intensive hemodialysis. Am J Kidney Dis, 2013, 62(1): 187-198.
14. Schünemann HJ, Zhang Y, Oxman AD, et al. Distinguishing opinion from evidence in guidelines. BMJ, 2019, 366: l4606.
15. Mustafa RA, Garcia CAC, Bhatt M, et al. GRADE notes: how to use GRADE when there is "no" evidence? A case study of the expert evidence approach. J Clin Epidemiol, 2021, 137: 231-235.
16. Merriam-Webster. Definition of opinion.
17. 孟醒, 崗衛娟, 修文萃, 等. 基于專家經驗的針刺療效影響因素分析. 中國針灸, 2022, 42(5): 585-589.
18. 徐偉超, 李佃貴, 杜艷茹. 基于當代京津冀名老中醫藥專家經驗的慢性萎縮性胃炎病因病機及證素規律研究. 遼寧中醫雜志, 2021, 48(4): 28-31.
19. 《中成藥治療優勢病種臨床應用指南》標準化項目組. 中成藥治療膝骨關節炎臨床應用指南(2020年). 中國中西醫結合雜志, 2021, 41(5): 522-533.
20. 梁葆朱, 趙子葦, 穆俊霞. 全國名老中醫藥專家經驗方臨床研究類文獻常見問題分析. 山西中醫藥大學學報, 2020, 21(2): 83-86.
21. 陳立柱. 中醫專家經驗繼承方法的拓展. 光明中醫, 2015, 4(4): 901-902, 903.
22. 王麗穎. 基于專家經驗和臨床證據的中成藥、西藥合用臨床實踐指南制訂的方法學研究. 中國中醫科學院中醫臨床基礎醫學研究所, 2013.
23. 趙小玲. 武漢市名老中醫專家經驗傳承數據庫建設. 武漢市中醫醫院, 2012.
24. 蔡德英. 名老中醫專家經驗的撰寫要點. 中國中醫藥信息雜志, 2012, 19(6): 97-97.
25. Antman EM, Lau J, Kupelnick B, et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA, 1992, 268(2): 240-248.
26. The Oxford Centre for Evidence-Based Medicine (CEBM). Explanation of the 2011 OCEBM levels of evidence. 2019.
27. Scottish Intercollegiate Guidelines Network 50: a guideline developer's handbook. 2019.
28. SUNY Downstate EBM Tutorial. Guide to research methods: the evidence pyramid. 2019.
29. 程勇. 中醫流派傳承發展面臨的問題與思考. 江蘇中醫藥, 2017, 49(2): 69-70.
30. 陳仁壽. 中醫流派研究中存在的問題與思考. 南京中醫藥大學學報(社會科學版), 2016, 17(4): 216-218.
31. 郜巒, 王振國, 張豐聰. 大數據背景下的地域性中醫學術流派研究. 世界科學技術-中醫藥現代化, 2018, 20(1): 32-36.

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