Non-alcoholic fatty liver disease (NAFLD) is a common disease of the digestive system. With the improvements of living standards and breakthroughs in viral hepatitis research, NAFLD has replaced viral hepatitis as the most common chronic liver disease. Guidance documents can provide clinical staff with standard and reliable diagnosis and treatment approaches. The screening and development of high-quality guidance documents is of great importance to standardise the clinical practice of NAFLD.
To analyze the methodological quality and reporting quality of guidance documents for NAFLD, summarize and compare the recommendations, so as to provide a reference for the development and report of future guidelines for NAFLD.
PubMed, CNKI, CBM, Wanfang Data Knowledge Service Platform, VIP Database were searched for clinical guidelines and consensuses on NAFLD supplemented by WHO, GIN, NICE, SIGN and Medlive from 2012-01-01 to 2022-01-01. Two researchers in the field of liver disease screened the literature, extracted the data and independently evaluated the methodological quality and reporting quality of the included guideline documents using AGREE Ⅱ and RIGHT, respectively. The recommendations of the higher quality guideline documents were collated and compared by the two researchers.
A total of 19 publications were enrolled, including 12 guidelines and 7 consensuses; 6 in Chinese and 13 in English; 10 of which were developed using an evidence-based approach. The average scores for each domain of AGREE Ⅱ were 42.84% for scope and purpose, 31.43% for participants, 31.25% for rigour, 60.67% for clarity, 32.68% for application and 37.50% for independence. The average scores of RIGHT in each area were 59.65% for basic information, 66.12% for background, 42.11% for evidence, 39.85% for recommendations, 17.11% for review and quality assurance, 18.42% for funding and conflict of interest statement and management, 47.37% for other aspects. The average scores in AGREEⅡ and reporting qualities in RIGHT of evidence-based guidance documents were both higher than non-evidence-based guidance documents. The average scores in AGREEⅡ and reporting qualities in RIGHT of foreign guidance documents were higher than domestic guidance documents. The main recommendations relate to screening and diagnosis, assessment, management (non-pharmacologic and pharmacologic treatment) and surgical treatment.
The methodological quality and reporting quality of the published guidance documents for NAFLD still need to be improved, and there are still gaps between domestic guidance documents and international guidance documents. The development of TCM guidance documents should follow an evidence-based approach. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the development and reporting of guidelines. Clinical screening awareness for high-risk population of NAFLD and a comprehensive system for early non-invasive diagnosis and assessment should be established. Multidimensional treatment plans for lifestyle, liver function and metabolic disorders should be provided for patients with NAFLD.
Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.
