Exercise is one of inexpensive and effective interventions for the prevention and treatment of postmenopausal osteoporosis, but relevant pieces of evidence are wide-ranging and fragmented, and there is no standardized and comprehensive exercise guidance program on clinic.
To screen and assess the evidence of exercise interventions for postmenopausal osteoporosis, then summarize the best pieces.
We systematically searched clinical practice guidelines, clinical decisions, evidence summaries, expert consensuses and systematic reviews regarding exercise interventions for postmenopausal osteoporosis in databases of BMJ Best Practice, Up To Date, DynaMed, National Institute for Health and Care Excellence, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, webs of Registered Nurses' Association of Ontario, International Osteoporosis Foundation, Royal Osteoporosis Society, National Osteoporosis Foundation, Royal Australian College of General Practitioners, American College of Obstetricians and Gynecologists, Society of Obstetrics and Gynaecologists of Canada, Medlive, JBI, Cochrane Library, CINAHL, Web of Science, PubMed, Embase, CNKI and SinoMed from inception to January 2022. All relevant evidence was summarized and extracted according to the theme. Appraisal of Guidelines for Research and Evaluation (AGREEⅡ) was used to evaluate the quality of the guidelines, Critical Appraisal for Summaries of Evidence (CASE) was used to evaluate the quality of clinical decisions, the authenticity assessment tool of the expert consensus of the JBI Evidence-Based Health Care Center in Australia (2016 edition) was used to evaluate the quality of expert consensuses, the Australian JBI Evidence-based Health Care Centre System Evaluation Methodology Quality Evaluation Tool (2016 edition) was used to evaluate the quality of the systematic reviews.
A total of 18 studies were included, including seven guidelines, two clinical decisions, four expert consensuses and five systematic reviews. Twenty-two pieces of evidence were extracted, involving five aspects: pre-exercise assessment, exercise type, exercise intensity and time, health education and precautions.
This paper extracts the best evidence of exercise intervention for postmenopausal osteoporosis patients from five aspects: pre-exercise assessment, exercise type, exercise intensity and time, health education and precautions. To reduce the risks of falls and fractures and improve quality of life in postmenopausal women with osteoporosis, it is suggested to provide these women with rational exercise guidance developed based on the best evidence.
Quality Assessment of Guidelines forVascular Cognitive Impairment Using the AGREEⅡ
As the second primary type of cognitive impairment worldwide, vascular cognitive impairment (VCI) is closely associated with cerebrovascular risks, which imposes a heavy burden on the society and families. Early diagnosis and treatment are important for intervening and reversing VCI. And formulating high-quality clinical guidelines is an effective way to improve diagnosis and treatment levels of VCI.
To assess the quality of guidelines for VCI, aiming at offering support for making clinical decisions for VCI.
From August to November 2021, we searched literature databases and websites in China and abroad to identify guidelines for VCI, and assessed them using the Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ.
A total of 18 guidelines were enrolled, 12 of which are Chinese guidelines and 6 are foreign guidelines; 9 of which are evidence-based guidelines, and the other 9 are not. The intraclass correlation coefficient was 0.935, indicating a high degree of agreement between raters. The overall quality of these guidelines was relatively low, since in the six domains, only the average score of Clarity of Presentation was greater than 60% (64.04%) , and the average scores of Scope and Purpose (52.31%) and Editorial Independence (42.01%) were between 30% and 60%, and those for other three domains, Stakeholder Involvement (27.24%) , Rigor of Development (20.05%) and Applicability (13.83%) , were all less than 30%. The grade of recommendation for 6 guidelines was B, and that for other 12 guidelines was C.
The overall quality of the included guidelines was rated relatively low, especially their average score for each of the three domains, Stakeholder Involvement, Rigor of Development, and Applicability, was below the average level. It is suggested to enhance the quality of VCI guidelines via improving the details of guidelines strictly under the evidence-based principle.
Best Evidence Summary for Perioperative Blood Glucose Management in Patients Undergoing Pancreatectomy
Blood glucose disorder is a common perioperative problem in patients with pancreatectomy. However, current perioperative blood glucose management for pancreatic resection patients in China is mostly based on experience and lack of evidence-based basis.
To summarize the best evidence for perioperative blood glucose management in patients undergoing pancreatectomy.
A systematic literature search of BMJ Best Practice, Up to Date, Guideline International Network, International Diabetes Federation, World Health Organization, National Guideline Clearinghouse, American Diabetes Association, the National Institute for Health and Care Excellence, New Zealand Guidelines Group, Canadian Diabetes Association, Australian Diabetes Society, Scottish Intercollegiate Guidelines Network, PubMed, Web of Science, EMBase, CINAHL Database, Cochrane Library, the Joanna Briggs Institute Evidence-based Health Care Center, Medlive.cn, Wanfang Data, CNKI, and Chinese Biomedical Database was conducted to screen the literature on perioperative blood glucose management in patients with pancreatectomy published from inception to December 2020. The AGREE Ⅱ scale updated in 2009 by the International AGREE Collaboration Organization was used to assess the quality of guidelines. The quality assessment of the expert consensus used the 2017 version of the expert consensus evaluation standard of the Australian JBI Evidence-based Health Care Center. The Jadad scale was used to assess the quality of randomized controlled trials (RCTs) .
A total of 6 637 studies were retrieved, and 13 of them were finally included, of which 7 were clinical practice guidelines, 4 were expert consensus, and 2 were RCTs. The results of quality assessment showed that 3 of the 7 clinical practice guidelines were rated grade A, and the remaining 4 were rated grade B. In assessing the quality of the 4 expert consensuses, the answers of raters for all items were "yes" , except that their answers for the item "Is there a reasonable explanation for the point of view inconsistent with other literature?" were "unclear" . Both the two RCTs were rated high. A total of 62 pieces of best evidence were collected, mainly related to perioperative organization and management, admission evaluation and treatment, blood glucose control goals, blood glucose monitoring, preoperative, intraoperative and postoperative blood glucose management strategies, management of emergency conditions, and discharge guidance.
Clinical medical workers can develop individualized and holistic perioperative blood glucose management plans for patients with pancreatectomy, based on the above-mentioned 9 aspects of best evidence.
Enteral nutrition support can effectively improve the nutritional status of patients with severe brain injury, which is beneficial to the prognosis of patients. However, the relevant literature in China and abroad lacks a systematic nutritional management plan for such patients, and there is rare summary of the best evidence for enteral nutrition support.
To retrieve and summarize the best evidence of enteral nutrition support in adult patients with severe brain injury, and provide evidence-based evidence for the clinical nutrition management of such patients.
All evidence on enteral nutrition in adult patients with severe brain injury was retrieved from databases and websites including BMJ Best Practice, Up To Date, GIN, NICE, NGC, RNAO, Yimaitong, ESPEN, ASPEN, SCCM, ESICM, JBI Library, Cochrane Library, PubMed, EMBase, CINAHL, CBM, CNKI, Wanfang Data, VIP. The retrieved evidence included guidelines, evidence summaries, best practices, expert consensus, systematic reviews and meta-analysis. The retrieval period was from April 2011 to April 2021. Corresponding quality evaluation criteria were used to evaluate the quality of the included literature, and the evidence was described and summarized using the JBI Evidence-based Health Care Center Evidence Pre-grading System (2014 edition) and JBI Evidence Recommendation Rating System (2014 edition) .
A total of 18 articles were included, including 5 clinical guidelines, 3 evidence summaries, 3 expert consensus, 2 systematic reviews, and 5 meta-analysis. Their methodological qualities were rated high overall. Finally 25 pieces of best evidence involving 8 aspects were nutrition screening, nutrition assessment, timing of initiating enteral nutrition, energy and protein requirements, enteral nutrition composition, feeding route, infusion method and complication management.
When giving enteral nutrition to adult patients with severe brain injury, medical staff need to implement it based on the best evidence. At the same time, an individualized enteral nutrition support program should be formulated in combination with the current medical status and specific treatment goals in China to improve the effect of nutritional support, thereby improving the clinical outcome of patients.
