Evaluation Of Stroke Guidelines And Consensus And Research On The Evidence Evaluation Scheme Of "modern And Contemporary Medical Experience

Objectives(1)To evaluate the clinical practice guidelines and expert consensus on Traditional Chinese Medicine(TCM)stroke diseases domestic and global by using various tools,taking stroke diseases,the dominant disease in TCM,as an example.To clarify the quality level of relevant guidelines,understand the value of clinical guidance of guidelines,and analyze the problems and deficiencies in current guidelines for stroke disease.At the same time,the characteristics of the applied evaluation tools are compared and explained to provide a reference basis for the revision of stroke related guidelines and consensus in the future.(2)Combine the problems found in the evaluation with the characteristics of Chinese medicine and the core aspects of guideline revision.Based on a comprehensive approach,we will explore the construction of a post-1911 evidence evaluation scheme for "modern medical experience" in TCM,in order to promote the standardization,clarity and transparency of guideline development,highlight the advantages and characteristics of TCM,reduce the practical problems that TCM guidelines"cannot be used,are not well used and will not be used".It also aims to reconcile the contradictions between traditional medicine and evidence-based medicine,and serve the development of TCM guidelines and consensus-related standards.Methods(1)Through systematic literature search and screening,domestic and foreign clinical practice guidelines and consensus on stroke disease that met the requirements were included.The quality of the guidelines and consensus was evaluated using AGREE II,AGREE China and the Quality Evaluation Checklist for Clinical Practice Guidelines in Chinese Medicine.The RIGHT for TCM was used to analyze the reporting norms of the above guidelines and consensus,analyze the evidence-based citations of the literature,and compare and explain the characteristics of each evaluation tool.(2)Using Qualitative research,modified Delphi method,and Analytic Hierarchy Process,we collected evaluation items and designed questionnaires through literature research and qualitative research,screened evaluation items by modified Delphi method,determined evaluation items,and constructed a hierarchical matrix to form an evaluation scheme for evidence of "modern medical experience" in TCM.and applied it by example.Results(1)Evaluation results:The study finally included 13 papers,including 8 clinical practice guidelines and 5 expert consensus for evaluation.The mean scores of the 13 papers in the 6 domains of AGREE Ⅱ were,from highest to lowest,92.88%for domain 1 scope and purpose,86.61%for domain 4 clarity,61.11%for domain 6 independence,56.84%for domain 2 participants,53.85%for domain 5 applicability,and 44.34%for domain 3 rigor.The mean score of the total AGREE-China score of the 13 documents was 55.87.Among the 5 major domains of AGREE-China,the highest score of usability/feasibility was 86.67%,the score of effectiveness/safety was 69.75%,the score of conflict of interest was 58.4%,the score of scientific/rigor was 45.6%,and the score of economy was lower at 18.4%.There are 22 entries in TCM,and three guidelines were found to report more than half of the entries through the evaluation,and the lower entries were mainly reported as 4-16 entries.The mean reporting rate for the 13 papers RIGHT for TCM was 58.06%.Among the seven domains,the domain reporting rate scores in descending order were 71.43%for domain 1 basic information,69.82%for domain 4 recommendations,62.50%for domain 2 context,50.77%for domain 3 evidence,50.00%for domain 5 review and quality assurance,38.46%for domain 7 other aspects,and 13.31%for domain 6 funding and conflict of interest statements and management.The literature included in the measurement in 42 entries did not report on sub-entries 18b and 19b.The three guidelines,Evidence-based Practice Guidelines for Integrating Chinese and Western Medicine in Stroke(2019),Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong,and Chinese Medicine Clinical Practice Guideline for Cerebral Infarction,had high overall scores as evaluated by the above tools.Examining the cited literature for evidence from the 10 eligible papers,interventional studies had the highest number of citations(180),followed by systematic evaluation/Meta-analysis(115),observational studies(62),guideline and norms(56),treatise theory(43),and ancient texts(13),with systematic evaluation type evidence increasing significantly in the last 10 years.(2)Collecting evaluation entries:Interview questionnaires were designed in conjunction with literature studies,and qualitative interviews were conducted to identify participants based on the principles of purposive sampling and information saturation,which divided into online Tencent conference interviews and offline face-to-face interviews.The information was transcribed and analyzed at the end of the interview,and the interview was ended when the information was saturated.The evaluation framework was formed by coding analysis through frame analysis method and cross-validation.29 interviewees from 8 provinces and cities and 24 units were included in the study.Combining literature research and qualitative research,we initially developed 30 evaluation items in four evaluation dimensions of the evidence of"modern medical experience" in TCM.(3)Screening evaluation entries:2 rounds of questionnaire research were conducted by modified Delphi method.In the first round,30 questionnaires were distributed and 29 were returned,with a recovery rate of 93.33%.In the second round,25 questionnaires were distributed,and 23 were returned,with a recovery rate of 92%.The survey experts have certain disciplinary and geographical representation.Cr=0.91 in the first round and Cr=0.92 in the second round.Cronbach’s alpha=0.953 in the first round and Cronbach’s alpha=0.884 in the second round.Mean coefficient of variation CV=0.24 in the first round and mean coefficient of variation CV=0.20 in the second round.The 30 evaluation items were screened according to the "boundary value method",and 15 items were deleted and 1 item was added in two rounds after combining the suggestions made by experts and the discussion of the subject group.Five entries and one dimension were revised.After the discussion in the working group meeting,the list of evaluations of evidence of modern medical practitioners’ experience in TCM was formed,including 4 evaluation dimensions and 16 evaluation entries.(4)Construction of evaluation matrix:Based on the dimensions and indicators of evaluation formed in the previous stage,the weights of each indicator were determined by hierarchical analysis.Based on the principles of multidisciplinary,authoritative and odd number,15 questionnaires were distributed,13 were returned,with a recovery ra te of 86.67%,Cr=0.92,and CI<0.1 for each level,and the comprehensive weights of each item were obtained by the "sum and product method":A.background of ph ysicians who presented their experience:A1.physician title(6.758%),A2.years of wo rk(9.948%),A3.clinical workload(10.150%),A4.educational background(5.521%).B.scientific and support degree of experience:B1.theoretical support(6.097%),B2.modern research supporting evidence(8.976%),B3.experience representation(9.158%),B4.applicability and contraindications(4.982%).C.transmission of experience:C1.ti me of transmission of experience(11.023%),C2.experience-related publications(5.874%),C3.other citations of experience papers(5.727%).D.applicability accessibility of experience:D1.peer review(3.349%),D2.patient evaluation(3.028%),D3.patient w illingness to follow-up visit(2.947%),D4.reproducibility of experience(3.869%),D5.generalizability of experience(2.593%).Conclusions(1)Several guideline evaluation tools are independent of each other and have their own characteristics,with the comprehensive use of a variety of tools,the guidelines can be evaluated from different perspectives in order to fully understand the current situation of the guidelines.(2)The TCM guidelines and consensus on stroke included in this study were generally well developed.With the development of evidence-based medicine and its popularization in China,the process of guideline development is gradually standardized and rigorous,which is a positive exploration of the standardization of TCM guidelines,but some aspects still need to be gradually improved:focus on multidisciplinary participation and reporting of conflict of interest statements,structure clinical questions with TCM characteristics,systematic search of evidence and regular updates,reasonable citation of TCM-specific evidence,adequate consideration of"patient values and preferences"and "health economics" elements.The report should emphasize the formation and aggregation of recommendations and present the basic information of the guidelines clearly.(3)By analyzing the original literature of guideline evidence,the number of citations is low,some of them are old,and the sources of citations are relatively single.In the absence of high-quality research evidence support,some of the recommendations for TCM diagnosis and treatment were derived from the ancient classics of TCM and expert experience,but the references or sources were not marked,and the process of recommendation formation was less clear.(4)The experience of modern medical practitioners is of great significance in guiding the clinical practice of TCM,especially in the absence of high-quality evidence,and attention should be paid to the rational application of TCM characteristic evidence.The evidence evaluation scheme of "modern medical experience" in TCM involves 16 entries in 4 dimensions.Through the combination of qualitative and quantitative evaluation of the experience of medical practitioners in multiple directions and levels,we can standardize the selection of the relatively better evidence of medical practitioners’ experience from many experiences,improve the standardization and transparency in the process of guideline.development,and ensure the usefulness of TCM guidelines.However,the content and scoring criteria of the entries in the program need to be continuously studied and calibrated,and revised and optimized according to the actual application.