Structured grading and evaluation of clinical questions in clinical practice guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yaqi ^1,2 , GAO Yicheng ^1,2 , SU Chengyuan ^1,2 , LIU Meijun ^1,2 , LI Xun ^1,2,3 ,  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;

Corresponding?author：

FEI Yutong, Email: feiyt@bucm.edu.cn

Keywords：

Clinical question; PICO; Clinical practice guideline; Methodology

DOI：

10.7507/1672-2531.202311037

Video：

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In the process of guideline development and construction of clinical questions, it is necessary to guide clinicians to propose clinical problems into PICO (population, intervention, control, outcome) structured clinical questions. However, there are still unclear criteria to define and judge the appropriateness of the width of the PICO elements of a clinical question. Either too wide or too narrow can make the PICO question unsuitable to be a question for clinical practice guidelines to answer. We graded the clinical questions to be eight grades (3, 2, 1, 0, ?1, ?2, ?3, mixed) according to the number of the PIC elements, which obviously needed to be adjusted to evaluate applicability of the appropriateness of the width of the clinical questions. Our work can provide methodological references for clinicians and guideline developers.

Citation： WANG Yaqi, GAO Yicheng, SU Chengyuan, LIU Meijun, LI Xun, FEI Yutong. Structured grading and evaluation of clinical questions in clinical practice guidelines. Chinese Journal of Evidence-Based Medicine, 2024, 24(7): 827-831. doi: 10.7507/1672-2531.202311037 Copy

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16.	呂琳, 吳景東. 不同階段帶狀皰疹的中西醫治療研究進展. 實用中醫內科雜志, 2024, 3: 1-5.
17.	魏敏, 閆言. 帶狀皰疹的藥物治療進展. 臨床藥物治療雜志, 2019, 17(11): 33-37.
18.	Werner RN, Nikkels AF, Marinovi? B, et al. European consensus-based (S2k) guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: treatment. J Eur Acad Dermatol Venereol, 2017, 31(1): 20-29.
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20.	中華醫學會骨科分會關節外科學組, 吳階平醫學基金會骨科學專家委員會. 膝骨關節炎階梯治療專家共識(2018年版). 中華關節外科雜志(電子版), 2019, 13(1): 124-130.
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25.	梁昌昊, 尹冠翔, 王雅琪, 等. 中醫藥臨床實踐指南制訂和修訂中德爾菲法應用的方法流程及建議. 協和醫學雜志, 2023, 14(5): 1084-1090.
26.	王郁, 王麗穎, 韓學杰. 基于文獻的中醫臨床實踐指南共識法專家遴選指標研究. 中醫藥學報, 2022, 50(5): 40-43.
27.	陳薇, 郭宇博, 方賽男, 等. 中醫藥臨床實踐指南中臨床問題的確定. 中國中西醫結合雜志, 2020, 40(2): 220-223.
28.	呂愛平, 趙靜, 姜淼. 中醫證候分類和復雜干預措施是影響中醫臨床療效評價的核心問題. 中國中西醫結合雜志, 2011, 31(4): 449-451.
29.	高一城, 夏如玉, 王雅琪, 等. 循證臨床實踐指南中臨床問題結構完整性及表述規范性的建議. 中國循證醫學雜志, 2023, 23(1): 120-124.
30.	National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. 2021.
31.	胡琳莉, 黃國寧, 孫海翔, 等. CSRM指南共識的制定規范(2016). 生殖醫學雜志, 2017, 26(4): 289-301.
32.	Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
33.	British Thoracic Society. British Thoracic Society standards of care committee guideline production manual. 2022.

1. World Health Organization. WHO handbook for guideline development. 2014.
2. Gupta S, Bhattacharyya OK, Brouwers MC, et al. Canadian Thoracic Society: presenting a new process for clinical practice guideline production. Can Respir J, 2009, 16(6): e62-e68.
3. Schardt C, Adams MB, Owens T, et al. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak, 2007, 7: 16.
4. Hoogendam A, de Vries Robbé PF, Overbeke AJ. Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. J Med Libr Assoc, 2012, 100(2): 121-126.
5. Mactier R. Renal Association clinical practice guideline development policy manual. Nephron Clin Pract, 2011, 118(Suppl 1): c13-c25.
6. Rosenfeld RM, Nnacheta LC, Corrigan MD. Clinical consensus statement development manual. Otolaryngol Head Neck Surg, 2015, 153(2 Suppl): S1-S14.
7. American Academy of Neurology. 2017 edition clinical practice guideline process manual. 2017.
8. Langer G, Meerpohl JJ, Perleth M, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. Z Evid Fortbild Qual Gesundhwes, 2012, 106(5): 369-376.
9. Infectious Diseases Society of America. Handbook for clinical practice guidelines development. 2021.
10. National Clinical Effectiveness Committee. Guideline developers manual. 2013.
11. New Zealand Guidelines Group. Handbook for the preparation of explicit evidence-based clinical practice guidelines. 2001.
12. 葛龍. 中醫藥/中西醫結合臨床實踐指南制訂方法學研究進展與展望. 中國藥物評價, 2022, 39(4): 279-284.
13. 楊超, 杜世豪, 王舢澤, 等. 基于改良德爾菲法構建《女性尿失禁針灸臨床實踐指南》臨床問題. 中國針灸, 2022, 42(8): 927-931.
14. Monagle P, Cuello CA, Augustine C, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2018, 2(22): 3292-3316.
15. 廖秀蓮. 針刺治療中風偏癱的臨床回顧性研究. 北京: 北京中醫藥大學, 2012.
16. 呂琳, 吳景東. 不同階段帶狀皰疹的中西醫治療研究進展. 實用中醫內科雜志, 2024, 3: 1-5.
17. 魏敏, 閆言. 帶狀皰疹的藥物治療進展. 臨床藥物治療雜志, 2019, 17(11): 33-37.
18. Werner RN, Nikkels AF, Marinovi? B, et al. European consensus-based (S2k) guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: treatment. J Eur Acad Dermatol Venereol, 2017, 31(1): 20-29.
19. Liu ZS, Peng WN, Liu BY, et al. Clinical practice guideline of acupuncture for herpes zoster. Chin J Integr Med, 2013, 19(1): 58-67.
20. 中華醫學會骨科分會關節外科學組, 吳階平醫學基金會骨科學專家委員會. 膝骨關節炎階梯治療專家共識(2018年版). 中華關節外科雜志(電子版), 2019, 13(1): 124-130.
21. 賴瑋婧, 劉芳, 付平. 慢性腎臟病評估及管理臨床實踐指南解讀—從K/DOQI到KDIGO. 中國實用內科雜志, 2013, 33(6): 448-453.
22. 張宏偉, 劉建平. 臨床試驗中的結局指標及效應測量. 中醫雜志, 2007, 48(8): 696-698.
23. National Health and Medical Research Council. Guidelines for guidelines: forming the questions. 2019.
24. 梁昌昊, 尹丁冉, 劉美君, 等. 中醫藥指南制訂中共識法應用關鍵要素的定性研究. 協和醫學雜志, 2024, 3: 1-15.
25. 梁昌昊, 尹冠翔, 王雅琪, 等. 中醫藥臨床實踐指南制訂和修訂中德爾菲法應用的方法流程及建議. 協和醫學雜志, 2023, 14(5): 1084-1090.
26. 王郁, 王麗穎, 韓學杰. 基于文獻的中醫臨床實踐指南共識法專家遴選指標研究. 中醫藥學報, 2022, 50(5): 40-43.
27. 陳薇, 郭宇博, 方賽男, 等. 中醫藥臨床實踐指南中臨床問題的確定. 中國中西醫結合雜志, 2020, 40(2): 220-223.
28. 呂愛平, 趙靜, 姜淼. 中醫證候分類和復雜干預措施是影響中醫臨床療效評價的核心問題. 中國中西醫結合雜志, 2011, 31(4): 449-451.
29. 高一城, 夏如玉, 王雅琪, 等. 循證臨床實踐指南中臨床問題結構完整性及表述規范性的建議. 中國循證醫學雜志, 2023, 23(1): 120-124.
30. National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. 2021.
31. 胡琳莉, 黃國寧, 孫海翔, 等. CSRM指南共識的制定規范(2016). 生殖醫學雜志, 2017, 26(4): 289-301.
32. Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
33. British Thoracic Society. British Thoracic Society standards of care committee guideline production manual. 2022.

Chinese Journal of Evidence-Based Medicine

Structured grading and evaluation of clinical questions in clinical practice guidelines

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