Chronic obstructive pulmonary disease (COPD) is a common, chronic heterogeneous airway disease. Although recent years have witnessed growing advances in both COPD research and management, there are still many difficulties need to be solved urgently. In view of this, the Lancet published Towards the Elimination of Chronic Obstructive Pulmonary Disease in September 2022, a document in which new ideas on the recognition, diagnosis, assessment and individualized treatment of COPD and relevant clinical guidance were proposed. This article focuses on the introduction and interpretation of the classification, diagnostic criteria and diagnostic recommendations of COPD in this document, the acute exacerbation of COPD and the move towards elimination of COPD, hoping to provide insights into COPD research and management conducted by Chinese clinical workers.
Enuresis in children is a common pediatric disease that can significantly reduce the quality of life of children and their families. High-quality guidelines on enuresis in children contribute to the standardization of control and improvement of clinical symptoms. So developing relevant high-quality clinical practice guidelines is a critical way to improve the diagnosis and treatment of enuresis in children.
To evaluate the quality of guidelines and expert consensuses on enuresis in children issued since 2010 using the AGREE Ⅱ and RIGHT checklists, aiming at providing a reference for clinical practice and future development of relevant guidelines.
Guidelines and expert consensuses related to enuresis in children published from January 1, 2010 to January 31, 2022 were searched in databases of CNKI, Wanfang Data, VIP, CBM, and PubMed (with searching databases of MedLive, WHO and NICE as a supplement) . The AGREE Ⅱ and RIGHT checklists were used to evaluate the methodological and reporting quality of included studies. According to the AGREEⅡ, the recommended grade of each guideline/consensus was rated as "recommended (A) ", "recommended after update (B) ", and "not recommended (C) ". The intra-class correlation coefficient (ICC) was used for the consistency test.
Altogether, eight guidelines and five consensuses were included, which provide 185 recommendations, including 44 for diagnosis and evaluation, 140 for treatment, and one for follow-up. By the AGREEⅡchecklist, these 13 studies were assessed with average scores of (66.99%±16.73%) , (46.26%±21.56%) , (34.42%±26.73%) , (60.36% ±32.13%) , (39.82%±20.14%) and (45.35%±37.93%) for scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence, respectively. None of the studies were with recommendation grade A, eight were with recommendation grade B, and five were with grade C. The reporting rates of the studies in accordance with seven domains of basic information, background, evidence, recommendations, review and quality assurance, funding and declaration and management of interests and other information were (60.58%±12.19%) , (50.72%±20.18%) , (30.77%±26.88%) , (32.97%±27.53%) , 25.00% (40.63%) , (25.96%±24.00%) and 16.67% (33.33%) , respectively. The guidelines had higher score in terms of the scope and purpose domain of AGREEⅡ than consensuses (P<0.05) . The guidelines and consensuses had no significant differences in assessment results by each of the seven domains of RIGHT (P>0.05) . The ICC for the reliability of each of the domains of the AGREEⅡchecklist in assessment was greater than 0.750, showing a high consistency. The ICC for the reliability of each of the domains of the RIGHT checklist was 0.736, which showed a good consistency.
The overall methodological and reporting quality of the included guidelines and consensuses needs to be improved. The recommended grades of the included literature consist of B and C without A, suggesting that high-quality guidelines should be referred first when making clinical decisions. Currently, there is no guideline for the diagnosis and treatment of enuresis in children in primary care in China, and the quality of existing guideline on Traditional Chinese Medicine management of enuresis in children needs to be improved. It is suggested to develop relevant guidelines according to the AGREE Ⅱ and RIGHT checklists to guide the clinical management of enuresis in children.
Culprit-only revascularization and complete revascularization are two major treatments for acute myocardial infarction (AMI) with multivessel disease. Many systematic reviews have compared the efficacy and safety of the two treatments, but the review results are inconsistent and cannot be directly applied to clinical practice.
To perform an overview of the systematic reviews of the efficacy and safety of complete revascularization versus culprit-only revascularization for AMI with multivessel disease.
PubMed, Cochrane Library, Embase and PROSPERO databases were searched from inception to February, 2022 for systematic reviews/meta-analyses about complete revascularization versus culprit-only revascularization for AMI with multivessel disease regardless of the language and status of publication. Two researchers independently evaluated the methodological quality and evidence quality of included studies using the AMSTAR 2 and GRADE, respectively.
A total of 25 systematic reviews or meta-analyses were included. The methodological quality of the included studies was generally low, with one being of high quality, two being of moderate quality, and 22 being of critical low quality. Eight outcomes and 135 evidence bodies (eight were of high quality, 17 were of moderate quality, and the rest were of low or very low quality according to the GRADE classification) were identified in the studies in total.
Compared with culprit-only revascularization, complete revascularization can partially improve clinical outcomes in patients with AMI with multivessel disease, but its safety needs to be further evaluated by high-quality, large-sample clinical studies.
