The planning and reporting of synthesis questions in systematic review of intervention have a direct and important impact on the validity of the evaluation and the credibility of the results. Planning helps to reduce bias in the evaluation process and ensure the reproducibility of data synthesis. However, the field of systematic review currently lacks specific checklists and tools to guide how to plan and report these issues. The InSynQ (Intervention Synthesis Questions) checklist is a tool designed for planning and reporting data synthesis issues in systematic reviews of interventions. Its goal is to promote the standardization of systematic review methods, support systematic review participants in planning and comprehensively reporting data synthesis issues and structures, and provide a more accurate evidence base for clinical decision-making.
The PICO model is a general model in building problems of evidence-based medicine (EBM). However, with the deepening and refinement of the medical research and the rising of qualitative research, the PICO model could not satisfy all problems. This article introduces the expansions of the PICO model and puts forward the SPIDER model according to the qualitative problem and its relationship with the PICO model, which can build the best search strategy of clinical problems in a short time.
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.
GRADE要求明確說明相關的背景、人群、干預措施和對照，同時要求不論研究結果能否形成證據，均需詳述所有重要結果。對某一特定管理問題，人群、干預措施及結果應在不同研究間足夠類似，才能認為得到相似的效應量合乎情理。指南制定者在收集證據前應先詳細說明各結局的相對重要性，同樣地，證據總結完成時也需要詳細說明這一點。考慮到替代結局的重要性，對采用替代指標描述且對患者很重要的結局，作者應評估其重要性，并進而降低這種間接結果的證據質量等級。