BMJ Evidence-Based Medicine最新文献

Objectives: To develop a generalised tool to evaluate the success of implementation of clinical practice guidelines (CPGs).

Design and setting: Systematic review, group brainstorming discussion and modified Delphi method.

Participants: A steering group (3 members) was assembled responsible for the guidance and ensuring stakeholder's involvement. A tool development group (24 members) of leading experts provided expertise in refining the frame and items during the development and participated in the Delphi process. And a secretary group (7 members) was responsible for the organization and coordination, systematic reviewing, drafting of the preliminary list of items, documenting and revising the tool according to the suggestions of the development group.

Interventions: Four process stages were employed. First, the project was launched with core groups formed for the development. Second, based on the Reach Effectiveness Adoption Implementation Maintenance framework, a systematic review of existing methods for evaluating the success of CPGs implementation and a brainstorming discussion were conducted to form a preliminary list. Third, a modified Delphi method was organised, integrating a multidisciplinary face-to-face consultation meeting with two rounds of online Delphi consultations. Fourth, the tool was revised and finalised incorporating all expert suggestions.

Results: Development teams comprising multidisciplinary experts were formed. In the systematic review, 7 biomedical literature databases were searched, and 208 pieces of literature were included. After three rounds of brainstorming discussions on items identified in the literature, a 23-item preliminary list was produced. In the modified Delphi method, 14 experts made 23 main suggestions in the face-to-face meeting on the list. 13 experts participated in the first round of Delphi consultation, reached agreement on 20 items, removed 4 items and added 1 new item. 11 experts attended the second-round consultation and had an agreement to include 20 items after revision.

Conclusions: The Guideline Implementation Success Assessment Tool (A-GIST) was systematically developed as a comprehensive tool to assess the success of CPGs implementation. It comprises 5 dimensions, Reach, Adoption, Implementation, Effectiveness and Maintenance, encompassing 20 items that integrate perspectives from both clinicians and patients. A-GIST is designed to facilitate evaluating, benchmarking and cross-comparison of implementation success between guidelines, facilities and regions. Additionally, it provides evidence-based insights to inform the development of targeted strategies for optimising guideline implementation practices.

Objectives: To investigate the reporting, data sharing and spin (using reporting strategies to emphasise the benefit of non-significant results) in acupuncture randomised controlled trials (RCTs).

Design: Cross-sectional meta-epidemiological study.

Data sources: Eligible studies indexed in MEDLINE, Embase, CENTRAL, CBM, CNKI, Wanfang Data and VIP Database between 1 January 2014 and 1 May 2024.

Eligibility criteria: Peer-reviewed acupuncture RCTs used traditional medicine (TM), published in English or Chinese, two parallel arms for humans.

Main outcome measures: We assessed (1) the reporting of acupuncture RCTs by the Consolidated Standards for Reporting Trials (CONSORT) 2010 statement and STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) checklist; (2) the data sharing level by the International Committee of Medical Journal Editors (ICMJE) data sharing statement; (3) spin frequency and level by the prespecified spin strategies.

Results: This study evaluated 476 eligible studies, of which 166 (34.9%) explored the specific efficacy or safety of acupuncture in the nervous system, 68 (14.3%) in the motor system and 61 (12.8%) in the digestive system. 244 (57.7%) studies used conventional acupuncture, 296 (62.2%) used multicentre study design and 369 (77.5%) were supported by institutional funding. 312 (65.5%) eligible studies were poorly reported. The sufficiently reporting scores of the CONSORT 2010 statement and the STRICTA checklist differed from 0.63% to 97.5%, and 32 (59.3%) items were less than 50%. For the data sharing level of acupuncture RCTs, only 66 (17.2%) studies followed the ICMJE data sharing statement, but 49 (14.5%) need to require authors to obtain data, and only 5 (1.5%) provided data by open access. Spins were identified in 408 (85.7%) studies (average spin frequencies: 2.94). 59 (37.2%) studies with non-significant primary outcomes had spin levels.

Conclusions: This study found that the reporting of acupuncture RCTs was low compliance with the CONSORT 2010 statement, the STRICTA checklist and the ICMJE data sharing statement, and spin appeared frequently. Journal policies on using reporting guidelines, data sharing and equitable consideration of non-significant results might enhance the reporting of acupuncture RCTs.

Trial registration number: This study was registered at the Open Science Framework (OSF): (https://doi.org/10.17605/OSF.IO/2WTE6, and https://doi.org/10.17605/OSF.IO/9XDN4,).

Existing reporting checklists lack the specificity and comprehensiveness required to effectively guide the documentation of acupuncture case reports. Therefore, we developed a reporting guideline tailored specifically for acupuncture case reports, building upon the CAse REport (CARE) statement. A multidisciplinary group of international experts including clinicians, researchers and methodologists was convened to draft the initial checklist in accordance with the methodology recommended by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. Through an extensive literature review and a series of expert interviews, the final CARE for acupuncture checklist comprised of 30 items. 38 experts from diverse disciplines participated in three rounds of modified Delphi surveys to refine and clarify these items. CARE for acupuncture is a comprehensive reporting guideline focused on acupuncture case reports developed with rigorous methodology. We hope that CARE for acupuncture will further guide authors, editors, peer reviewers and readers to enhance the transparency, completeness and accuracy of reporting of case reports in acupuncture.