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Evidence synthesis is the synthesis of existing research using a systematic and appropriate method. Various types of evidence synthesis are currently in use. Correctly choosing and applying the best evidence synthesis method is crucial for researchers, policymakers, and stakeholders. Thus, based on summarizing the current situation, progress, and classification of evidence synthesis methods, we introduced the definition and characteristics of common evidence synthesis methods and problems in their application, and presented thoughts and suggestions for the problems in the application of evidence synthesis methods.

Background Clinical practice guidelines in primary care are important tools to guide primary care practice, but they are found with relatively low quality and unstandardized reporting on the whole. Objective To develop the reporting guideline for clinical practice guidelines in primary care based on the Reporting Items for practice Guidelines in HealThcare (RIGHT) . Methods According to the reporting methods recommended by EQUATOR Network, an item development group and an expert consensus group were established to develop reporting guideline for clinical practice guidelines in primary care. Content analysis, brainstorming, and topic analysis were used in developing the initial items. The Delphi survey was conducted to determine the final items. Results Thirteen items (five were modified and eight were added) were developed initially, covering five domains: guideline title, health issues, intended setting, recommendations and suggestions for future research. Then the initial item checklist was revised to a final version consisting of 15 items according to the results of two rounds of Delphi survey (with 100% response rates from 22 experts) conducted from December 2 to December 26, 2022. Conclusion This reporting checklist will provide a detailed guide for developers of guidelines in primary care, which will further improve the reporting quality of guidelines in primary care, especially that of those in China.

Background The clinical practice guidelines in general practice can improve healthcare quality in primary health care, however, no study has yet systematically investigated the current status and quality of the guidelines in China. Objective To investigate the current status and influencing factors of quality of the guidelines in China. Methods We searched China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese biomedical literature database, and CQVIP website, and included the published guidelines in China. We analyzed the basic characteristics and used RIGHT to evaluate the reporting quality and AGREE-China for methodological quality. Results A total of 150 guidelines were included, mainly published from 2019 to 2021. Most of the guidelines〔108 (72.0%) 〕focused on the diagnosis and treatment of diseases. The top three specialties were cardiovascular disease〔40 (26.7%) 〕, gastroenterology〔31 (20.7%) 〕, and clinical pharmacy〔27 (18.0%) 〕. The main development institutions were the Chinese Medical Association and its branches〔123 (82.0%) 〕, the editorial committee of the Chinese Journal of General Practitioners〔119 (79.3%) 〕, and the Chinese Medical Journals Publishing House〔116 (77.3%) 〕. In terms of reporting quality, the average reporting rate of RIGHT was 23.6% (11.4%-42.9%) ; the reporting rate of basic information (59.8%) was higher, and that of evidence (0.3%) was the lowest. As for methodological quality, the average AGREE-China score was 23.4 (12.0-40.0) ; the reporting rates of conflicts of interest (63.0%) and availability/feasibility (53.0%) were higher, and that of economics (7.0%) was the lowest. Conclusion The number of Chinese clinical practice guidelines in general practice has increased rapidly in the past five years, which has played an important role in promoting the quality of primary health care. In the future, it is necessary to further develop the guidelines in different specialties and diseases and accelerate the methodology of development and reporting of the guidelines.

Objective To compare and analyze the recommendations for the timing and frequency of home blood pressure monitoring (HBPM) in clinical practice guidelines to help clinicians select the best recommendations and provide suggestions for the development of recommendations in the future. Methods Clinical practice guidelines related to hypertension published in the last five years were systematically searched and screened, and the recommendations for the timing and frequency of HBPM were extracted for statistical analysis. Results A total of 21 guidelines developed by institutions in 16 countries or regions were included, containing recommendations related to the timing and/or frequency of HBPM. For the HBPM timing, all guidelines recommend that blood pressure measurements be taken twice a day, in the morning and evening. In the morning blood pressure should be measured before taking antihypertensive medication (94.4%, 17/18), before breakfast (72.2%, 13/18) and after urination (55.6%, 10/18), while in the evening it should be taken before dinner (50.0%, 8/16), before bedtime (37.5%, 6/16) or 2 hours after dinner (6.3%, 1/16).For HBPM frequency, 9 (40.9%, 9/22) guidelines recommend at least 3 consecutive days of measurement in the week before the visit, and others suggest that measurements should be taken consecutively for at least 4 d (18.2%, 4/22), 5 d (13.6%, 3/22) or 7 d (27.3%, 6/22) days. Conclusions The guidelines of different countries and regions have great differences in recommendations on the timing and frequency of HBPM. It is recommended that future guideline developers develop the best recommendations after a thorough search, evaluation, and synthesis of the evidence, with full consideration of the balance of pros and cons, feasibility, patient preferences and values, as well as the context in which the guidelines are implemented.

Objective To investigate the reporting status of abstracts of Chinese clinical practice guidelines published in medical journals in 2019 and provide a reference for related researchers to write guideline abstracts and develop the reporting standard. Methods We systematically searched four electronic databases and additional sources for Chinese clinical practice guidelines published in medical journals in 2019. Four researchers independently screened the identified literature and extracted data related to abstracts. We analyzed the current status of abstract report, evaluated the reporting quality of guideline abstracts using the preliminary RIGHT-Abstract reporting checklist (consisting of 7 domains and 19 items) and assessed the consistency between the abstract and the main text. Results A total of 226 guidelines were finally included, 96(42.5%) of which included abstracts. Among the 96 guidelines, 79(82.3%, 79/96) were published in Chinese and 17(17.7%, 17/96) were published in English. Among the 79 guidelines in Chinese, 52(65.8%, 52/79) provided bilingual abstracts in both Chinese and English. Of the 96 guidelines with abstracts, only 6(6.3%) guidelines included structured abstracts, and 16(16.7%) guidelines reported the main contents of recommendations in the abstract. The reporting rates in each RIGHT-Abstract domain were as follows: 61.0%(background), 13.0%(methods), 7.3%(results), 1.0%(review), 0(discussion, registry and funding). In terms of the consistency in content between the abstract and the main text, the item with the best consistency was the 'diseases and health problems'(91.7%), followed by the 'purpose '(78.1%), 'target populations '(70.8%), 'users'(38.5%) and 'developers '(38.5%). For the rest of items, the consistencies were less than 20.0%. Conclusions The proportion of Chinese clinical practice guidelines published in medical journals in 2019 that included abstracts was relatively low, especially the structured abstracts, and the guideline abstracts provided limited information. It is necessary to develop and promote the formal reporting standard for the guideline abstracts in the future, so as to provide a guidance for related researchers.

Objective To analyze the status of dissemination and implementation of Chinese clinical practice guidelines published in medical journals in 2019, and to propose suggestions on promoting the dissemination and implementation of Chinese guidelines in the future. Methods We analyzed Chinese guidelines published in 2019 on the following aspects: reporting the dissemination and implementation; being published in multiple journals, editions and languages. Besides, we also searched published interpretation reports related to 2019 Chinese guidelines so as to understand the status of dissemination and implementation of guidelines in China. Results A total of 226 Chinese guidelines published in medical journals in 2019 were identified. Only 5.8% (13/226) reported the information on dissemination and implementation with 12 different strategies. Dissemination and implementation by academic conferences and social media were mostly mentioned and reported in 8 guidelines. As for the application of the strategies of dissemination and implementation, 12.4% (28/226) published in different journals; 9.3% (21/226) published different editions; 8.4% (19/226) published both English and Chinese versions. After search and screening, we included 48 interpretation reports, which interpreted 30 (13.3%, 30/226) Chinese guidelines. The median interval of publication time between the guideline and interpretation study was 5.5 months. Conclusions The reporting rate of dissemination and implementation and the application of related strategies of Chinese guidelines published in 2019 were relatively low. We suggest that guideline developers should develop specific and detailed strategies on guideline dissemination and implementation, and follow the reporting guidance.

Objective To evaluate the methodological and reporting quality of Chinese clinical practice guidelines published in medical journals in 2019, so as to understand their current quality and provide suggestions for the improvement of guideline development. Methods We used the AGREE Ⅱ tool and the RIGHT checkilist to assess the methodological and reporting quality of Chinese clinical practice guidelines respectively. The average score or average reporting rate was calculated for each domain and the overall. We used 60% as the qualified threshold. Results A total of 226 guidelines meeting the criteria were included. The average score of AGREE Ⅱ was 22.3%, and the scores of six domains were as follows: 37.9% (scope and purpose), 23.2% (stakeholder involvement), 14.9% (rigour of development), 39.1% (clarity of presentation), 14.6% (applicability), and 22.5%(editorial independence). The average reporting rate of RIGHT was 33.9%, and the reporting rates of seven domains were as follows: 59.2% (basic information), 51.9% (background), 10.8% (evidence), 31.5% (recommendation), 4.4% (review and quality assurance), 22.3%(funding and declaration and management of interests), and 14.5% (other information). Compared to unregistered guidelines, 12 registered guidelines had a 24.3% higher mean score (48.3% vs. 24.0%) in AGREE Ⅱ and a 21.2% higher mean reporting rate (54.0% vs. 32.8%) in RIGHT. Conclusions The overall methodological and reporting quality of Chinese clinical practice guidelines published in medical journals in 2019 were relatively low. Registered guidelines had higher overall scores than unregistered guidelines.

Mitochondrial membrane potential (MMP) and sulfur dioxide (SO 2 ) significantly affect the mitochondrial state. In this work, TC-2 and TC-8 were constructed through side-chain engineering, in which TC-2 bearing the poorer hydrophobicity could localize on mitochondria better. Interestingly, short-wave emission was captured due to the sensitive response of TC-2 to SO 2 (LOD = 13.8 nM). Meanwhile, the probe could bind with DNA, presenting enhanced long-wave emission. Encouragingly, TC-2 could migrate from mitochondria to the nucleus when MMP was decreased, accompanied by the increase of fluorescence lifetime (9-fold). Hence, TC-2 could be used for dual-channel monitoring of mitochondrial SO 2 and MMP, which showed a completely different pathway from the commercial MMP detectors JC-1/JC-10. The cellular experiments showed that MMP was gradually decreased due to reactive oxygen species-triggered oxidative stress, and the SO 2 level was up-regulated simultaneously. Overall, this work proposed a new method to investigate and diagnose the mitochondrial-related diseases.

Objective: Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, but there is so far no comprehensive analysis of all known symptoms of the disease. Our study aimed to present a comprehensive picture of the clinical symptoms of COVID-19 using an evidence map., Methods: We systematically searched MEDLINE via PubMed, Web of Science, Embase, and Cochrane library from their inception to March 16, 2021. We included systematic reviews reporting the clinical manifestations of COVID-19 patients. We followed the PRISMA guidelines, and the study selection, data extraction, and quality assessment were done by two individuals independently. We assessed the methodological quality of the studies using AMSTAR. We visually presented the clinical symptoms of COVID-19 and their prevalence., Results: A total of 102 systematic reviews were included, of which, 68 studies (66.7%) were of high quality, 19 studies (18.6%) of medium quality, and 15 studies (14.7%) of low quality. We identified a total of 74 symptoms including 17 symptoms of the respiratory system, 21 symptoms of the neurological system, 10 symptoms of the gastrointestinal system, 16 cutaneous symptoms, and 10 ocular symptoms. The most common symptoms were fever (67 studies, ranging 16.3%-91.0%, pooled prevalence: 64.6%, 95%CI, 61.3%-67.9%), cough (68 studies, ranging 30.0%-72.2%, pooled prevalence: 53.6%, 95%CI, 52.1%-55.1%), muscle soreness (56 studies, ranging 3.0%-44.0%, pooled prevalence: 18.7%, 95%CI, 16.3%-21.3%), and fatigue (52 studies, ranging 3.3%-58.5%, pooled prevalence: 29.4%, 95%CI, 27.5%-31.3%). The prevalence estimates for COVID-19 symptoms were generally lower in neonates, children and adolescents, and pregnant women than in the general populations., Conclusion: At least 74 different clinical manifestations are associated with COVID-19. Fever, cough, muscle soreness, and fatigue are the most common, but attention should also be paid to the rare symptoms that can help in the early diagnosis of the disease., (© 2022 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Objective: Since the beginning of the COVID-19 epidemic, a large number of guidelines on diagnosis and treatment of COVID-19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID-19 and analyze the consistency of the recommendations of these guidelines., Methods: We searched for guidelines on diagnosis and/or treatment of COVID-19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID-19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID-19 across the included guidelines., Results: A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X-rays, lung ultrasound, RT-PCR, and routine blood tests were the most commonly recommended methods for COVID-19 diagnosis. Thirty guidelines were on the treatment of COVID-19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy., Conclusions: The methodological quality of currently available diagnosis and treatment guidelines for COVID-19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID-19 are RT-PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID-19 yet, supportive therapy is at the moment the most important treatment option., (© 2021 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Background: Supportive treatment is an important and effective part of the management for patients with life-threatening diseases. This study aims to identify and evaluate the forms of supportive care for patients with respiratory diseases., Methods: An umbrella review of supportive care for patient with respiratory diseases was undertaken. We comprehensively searched the following databases: Medline, EMBASE, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang Data and CBM (SinoMed) from their inception to 31 March 2020, and other sources to identify systematic reviews and meta-analyses related to supportive treatments for patient with respiratory diseases including Coronavirus Disease 2019 (COVID-19), severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and influenza. We assessed the methodological quality using the AMSTAR score and the quality of the evidence for the primary outcomes of each included systematic review and meta-analysis., Results: We included 18 systematic reviews and meta-analyses in this study. Most studies focused on the respiratory and circulatory support. Ten studies were of high methodological quality, five studies of medium quality, and three studies of low quality. According to four studies extracorporeal membrane oxygenation did not reduce mortality in adults [odds ratio/relative risk (OR/RR) ranging from 0.71 to 1.28], but two studies reported significantly lower mortality in patients receiving venovenous extracorporeal membrane oxygenation than in the control group (OR/RR ranging from 0.38 to 0.73). Besides, monitoring of vital signs and increasing the number of medical staff may also reduce the mortality in patients with respiratory diseases., Conclusions: Our overview suggests that supportive care may reduce the mortality of patients with respiratory diseases to some extent. However, the quality of evidence for the primary outcomes in the included studies was low to moderate. Further systematic reviews and meta-analyses are needed to address the evidence gap regarding the supportive care for SARS, MERS and COVID-19., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3298). MSL serves as the unpaid editorial board member of Annals of Translational Medicine from Nov 2019 to Oct 2021. The other authors have no conflicts of interest to declare., (2020 Annals of Translational Medicine. All rights reserved.)

Background: The outbreak of the coronavirus disease 2019 (COVID-19) has had a massive impact on the whole world. Computed tomography (CT) has been widely used in the diagnosis of this novel pneumonia. This study aims to understand the role of CT for the diagnosis and the main imaging manifestations of patients with COVID-19., Methods: We conducted a rapid review and meta-analysis on studies about the use of chest CT for the diagnosis of COVID-19. We comprehensively searched databases and preprint servers on chest CT for patients with COVID-19 between 1 January 2020 and 31 March 2020. The primary outcome was the sensitivity of chest CT imaging. We also conducted subgroup analyses and evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach., Results: A total of 103 studies with 5,673 patients were included. Using reverse transcription polymerase chain reaction (RT-PCR) results as reference, a meta-analysis based on 64 studies estimated the sensitivity of chest CT imaging in COVID-19 was 99% (95% CI, 0.97-1.00). If case reports were excluded, the sensitivity in case series was 96% (95% CI, 0.93-0.99). The sensitivity of CT scan in confirmed patients under 18 years old was only 66% (95% CI, 0.15-1.00). The most common imaging manifestation was ground-glass opacities (GGO) which was found in 75% (95% CI, 0.68-0.82) of the patients. The pooled probability of bilateral involvement was 84% (95% CI, 0.81-0.88). The most commonly involved lobes were the right lower lobe (84%, 95% CI, 0.78-0.90) and left lower lobe (81%, 95% CI, 0.74-0.87). The quality of evidence was low across all outcomes., Conclusions: In conclusion, this meta-analysis indicated that chest CT scan had a high sensitivity in diagnosis of patients with COVID-19. Therefore, CT can potentially be used to assist in the diagnosis of COVID-19., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3311). MSL serves as the unpaid editorial board member of Annals of Translational Medicine from Nov 2019 to Oct 2021. The other authors have no conflicts of interest to declare., (2020 Annals of Translational Medicine. All rights reserved.)

BackgroundIn December 2019, a pneumonia caused by a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China and has rapidly spread around the world since then.AimThis study aims to understand the research gaps related to COVID-19 and propose recommendations for future research.MethodsWe undertook a scoping review of COVID-19, comprehensively searching databases and other sources to identify literature on COVID-19 between 1 December 2019 and 6 February 2020. We analysed the sources, publication date, type and topic of the retrieved articles/studies.ResultsWe included 249 articles in this scoping review. More than half (59.0%) were conducted in China. Guidance/guidelines and consensuses statements (n = 56; 22.5%) were the most common. Most (n = 192; 77.1%) articles were published in peer-reviewed journals, 35 (14.1%) on preprint servers and 22 (8.8%) posted online. Ten genetic studies (4.0%) focused on the origin of SARS-CoV-2 while the topics of molecular studies varied. Nine of 22 epidemiological studies focused on estimating the basic reproduction number of COVID-19 infection (R 0 ). Of all identified guidance/guidelines (n = 35), only ten fulfilled the strict principles of evidence-based practice. The number of articles published per day increased rapidly until the end of January.ConclusionThe number of articles on COVID-19 steadily increased before 6 February 2020. However, they lack diversity and are almost non-existent in some study fields, such as clinical research. The findings suggest that evidence for the development of clinical practice guidelines and public health policies will be improved when more results from clinical research becomes available.