Acupuncture Clinical Practice Guidelines Developed In The Literature Search, Evaluation Of Evidence And Expert Consensus Method

BackgroundIn 1990 Institute of Meicine Committee to Advise the Public Health Service on Clinical Practice Guidelines defined Clinical Practice Guidelines(CPG) as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances".In 1993 Scottish Intercollegiate Guidelines Network (SIGN) was found.It has already developed more than sixty guidelines and remains bellwether of institutes of developing guidelines.In 2003 World Health Organization(WHO) published GUIDELINES FOR WHO GUIDELINES which defined CPG as "Guidelines are systematically developed evidence-based statements which assist providers,recipients and other stakeholders to make informed decisions about appropriate health interventions." In recent years,guidelines research institutes in globe have been established and grown in England,American,New Zealand,Canada and Australia etc which study on development of guidelines and evaluation. Based on incomplete statistic a article reports that the increasing number of guidelines searched in Medline database from 1994 to 2003,in past ten years there are 6462 guidelines and average 640 each year but least and most respectively 452 in 1994 and 897 in 2004.CPG enter into growing number period.Methodology of CPG standing at elementary period but is precondition of development of guidelines.Basement of developing guideline can be improved and revised by the methods of guidelines research.It's core includes that searching literature,grade of evidence,qualifying literature,strength of recommendation,methods of specialists' consensus and setting up development and popularized mode and system of acupuncture clinical evaluation literature of CPG.These works are difficult in studying on methodology of guidelines.We can break through from solving those problems.In hence,it makes sense that improving methods of guideline.Although SIGN has developed many CPGs,it improve its methodology and challenge in future.Besides,National Institute for Clinical Excellence(NICE) published that Guideline Development Methods in 2004 and was revised in 2005 which completely supplies for methods of development of guidelines.In field of Traditional Chinese Medicine(TCM) CPG increase year by year. There are developed guidelines,such as guideline of diagnosis and treatment for Severe Acute Respiratory Syndrome(SARS) of TCM,guideline for Sub-health of TCM,guideline of diagnosis and treatment for Acquired Immune Deficiency Syndrome(AIDS) of TCM.Assignment about developing guidelines of TCM was written by World Health Organization West-pacific region(WHO-WPR) in December 2006.Twenty-seven guidelines for TCM and five for acupuncture are developing.Because of characteristics of TCM subject,acupuncture subject,clinical research of TCM and acupuncture, literature of TCM and acupuncture,methodology of development of CPG of TCM and ACPG will be challenge.Qualitative study methods in social medicine are applied broadly,for example Brainstorm can improve quality of care,Delphi can be used to study on medical researches and decisions and so on.I study on consult to experts and collect advices of consensus according to studying literature and applying sociology such as methods of brainstorm,Delphi, questionnaire-inquisition,etc.Then I explore that methodology of CPG and advance methods and advices.ObjectiveAdvising for methodology of strategy of searching literature,grade of evidence,qualifying literature,strength of recommendation,ethods of specialists' consensus and setting up development and popularized mode and system of acupuncture clinical evaluation literature of ACPG.Contents and ResultsAt firstⅠadvice that strategy of searching literature in ACPG, structuring acupuncture literature evaluating system,methods and strategies of acupuncture clinical literature;putting forward advice of grading criterion and shaping evaluating standard of literature quality and recommendation standard,discussing methods of specialists' consensus and setting up development and popularized mode of ACPG.Creationary PointsCombining with EBM,this thesis firstly brings forward not only that the searching scope,methods and strategies of acupuncture clinical literature;putting forward advice of grading criterion and shaping evaluating standard of literature quality and recommendation standard, but also advice of specialists' consensus methods.Besides these,this paper establishes development and popularized mode of ACPG at first step. These studies will supply for later methodology researches of guidelines for TCM and development of next ACPG. DiscussionThe Precondition of development of ACPG is how to combine methodology of guideline with acupuncture clinical research.Abiding by reason and methods of EBM we can solve that core problem of methodology studies of ACPG,including methods and strategy of acupuncture literature searching, standards of grading acupuncture literature,evaluating evidence, strength of recommendation,specialists' consensus for treatment and mode of developing and popularizing guidelines.It makes sense that improving studies on methodology of guideline development. Analyzing and discussing the difficulties of methodology of ACPG we can bring forward that prospective of research on next step.