AGREE-S

AGREE - S
  • 文章类型: Journal Article
    背景:造口旁疝在永久性结肠造口术后经常出现。以前的指南建议使用预防性网片预防疝气。此后发表的随机对照试验(RCTs)显示结果相互矛盾。方法和分析:将根据GRADE制定和报告快速指南,GIN和AGREE-S标准。指导小组将由普通和结直肠外科医生组成,EHS科学顾问委员会成员,在指南制定方面具有专业知识和经验,先进的医学统计和证据综合,和经过认证的指导方法学家。指引小组将由三名普通外科医生组成,三个结直肠外科医生,两名造口护理护士,和两名患者代表。一个问题将解决永久性结肠造口术患者使用预防性网状物的安全性和有效性,和敏感性分析将集中在使用不可吸收的网格和可吸收的网格,并在不同的解剖空间上进行网格放置。将进行系统审查,并由统计学家独立进行证据综合。证据综合的结果将总结在结果表摘要中。建议将在证据到决策框架内通过指南小组的Delphi过程最终确定。伦理和传播:资助机构将不参与本指南的制定。利益冲突,如果有的话,将通过重新分配职能或替换具有直接冲突的参与者来解决,根据国际网络指南的建议。
    Background: Parastomal hernia presents frequently after construction of a permanent end colostomy. Previous guidelines recommend using a prophylactic mesh for hernia prevention. Randomized controlled trials (RCTs) published hereafter demonstrate conflicting outcomes. Methods and Analysis: A rapid guideline will be developed and reported in accordance with GRADE, GIN and AGREE-S standards. The steering group will consist of general and colorectal surgeons, members of the EHS Scientific Advisory Board with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, and a certified guideline methodologist. The guideline panel will consist of three general surgeons, three colorectal surgeons, two stoma care nurses, and two patient representatives. A single question will address the safety and efficacy of the use of a prophylactic mesh in patients with a permanent end colostomy, and sensitivity analyses will focus on the use of non-absorbable versus absorbable meshes, and on different anatomical spaces for mesh placement. A systematic review will be conducted and evidence synthesis will be performed by statisticians independently. The results of evidence synthesis will be summarized in summary of findings tables. Recommendation(s) will be finalized through Delphi process of the guideline panel within an evidence-to-decision framework. Ethics and Dissemination: The funding body will not be involved in the development of this guideline. Conflicts of interest, if any, will be addressed by re-assigning functions or replacing participants with direct conflicts, according to Guidelines International Network recommendations.
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  • 文章类型: Systematic Review
    缺乏治疗妊娠期急性阑尾炎的临床实践建议。
    为了建立一个有证据的,关于妊娠阑尾炎管理的可靠指南。我们旨在解决保守或手术管理的问题,和腹腔镜或开腹手术治疗急性阑尾炎。
    我们进行了系统评价,荟萃分析,和使用等级方法进行证据评估。一个欧洲人,多学科外科医生小组,产科医生/妇科医生,助产士,3名患者代表通过证据决策框架和Delphi程序制定建议达成共识.该项目是在在线创作和出版平台(MAGICapp)中开发的。
    研究证据的确定性非常低。在影像学检查中,我们建议对患有复杂性阑尾炎或阑尾结石的孕妇进行手术治疗,而不是保守治疗(强烈建议)。我们建议对无并发症阑尾炎且无阑尾结石的孕妇进行手术治疗,而不是保守治疗(弱推荐)。我们建议对急性阑尾炎患者进行腹腔镜阑尾切除术,直至妊娠20周,或当子宫底低于脐部水平时;妊娠20周以上急性阑尾炎患者的腹腔镜或开腹阑尾切除术,或者当子宫底高于脐部时,取决于外科医生的偏好和专业知识。
    通过一个结构化的,循证方法,一个跨学科小组提供了一个强有力的建议,以进行复杂的阑尾炎或阑尾结石的阑尾切除术,20周后进行腹腔镜或开腹阑尾切除术,根据外科医生的偏好和专业知识。
    IPGRP-2022CN210。
    Clinical practice recommendations for the management of acute appendicitis in pregnancy are lacking.
    To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis.
    We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp).
    Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon.
    Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon\'s preference and expertise.
    IPGRP-2022CN210.
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  • 文章类型: Systematic Review
    胆总管结石在胆囊疾病患者中占相当比例。有几个管理选项,包括术前或术中内镜胰胆管造影(ERCP),和腹腔镜胆总管探查术(LCBDE)。
    为了发展证据,跨学科,欧洲关于在完整胆囊的情况下处理胆总管结石的建议,临床决定干预胆囊和胆总管结石。
    我们更新了LCBDE的系统评价和网络荟萃分析,术前,术中,和术后ERCP。我们使用等级和CINeMA方法形成了证据摘要,和一个普通外科医生小组,胃肠病学家,一名患者代表为GRADE证据决策框架的开发做出了贡献,该框架可在多种干预措施中进行选择。
    专家组就第一轮德尔福达成了一致共识。我们建议LCBDE术前,术中,或术后ERCP,当具有手术经验和专业知识时;术中ERCP超过LCBDE,术前或术后ERCP,当这在给定的医疗保健环境中在逻辑上是可行的;术前ERCP超过LCBDE或术后ERCP,术中ERCP不可行且LCBDE经验或专业知识不足(弱推荐)。证据摘要和决策辅助工具可在MAGICapp平台(https://app。magicapp.org/#/guideline/nJ5zyL)。
    我们制定了符合最新方法学标准的快速胆总管结石治疗指南。医疗保健专业人员和其他利益相关者可以使用它来告知临床和政策决定。
    IPGRP-2022CN170。
    Choledocholithiasis presents in a considerable proportion of patients with gallbladder disease. There are several management options, including preoperative or intraoperative endoscopic cholangiopancreatography (ERCP), and laparoscopic common bile duct exploration (LCBDE).
    To develop evidence-informed, interdisciplinary, European recommendations on the management of common bile duct stones in the context of intact gallbladder with a clinical decision to intervene to both the gallbladder and the common bile duct stones.
    We updated a systematic review and network meta-analysis of LCBDE, preoperative, intraoperative, and postoperative ERCP. We formed evidence summaries using the GRADE and the CINeMA methodology, and a panel of general surgeons, gastroenterologists, and a patient representative contributed to the development of a GRADE evidence-to-decision framework to select among multiple interventions.
    The panel reached unanimous consensus on the first Delphi round. We suggest LCBDE over preoperative, intraoperative, or postoperative ERCP, when surgical experience and expertise are available; intraoperative ERCP over LCBDE, preoperative or postoperative ERCP, when this is logistically feasible in a given healthcare setting; and preoperative ERCP over LCBDE or postoperative ERCP, when intraoperative ERCP is not feasible and there is insufficient experience or expertise with LCBDE (weak recommendation). The evidence summaries and decision aids are available on the platform MAGICapp ( https://app.magicapp.org/#/guideline/nJ5zyL ).
    We developed a rapid guideline on the management of common bile duct stones in line with latest methodological standards. It can be used by healthcare professionals and other stakeholders to inform clinical and policy decisions.
    IPGRP-2022CN170.
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  • 文章类型: Journal Article
    背景:成人GERD的外科治疗有几种选择。以前的指南和系统综述比较了完全胃底折叠术的效果与不同部分胃底折叠术技术的综合效果。
    目的:为了建立证据,值得信赖,关于使用总量的相关建议,成人GERD治疗的后部部分和前部部分胃底折叠。
    方法:我们进行了最新的系统评价,网络荟萃分析,使用GRADE和网络元分析方法的信心进行证据评估。一个国际,多学科外科医生小组,胃肠病学家,患者代表通过证据决策框架达成一致共识,在多种干预措施中进行选择,和Delphi程序来制定建议。该项目是在在线创作和出版平台(MAGICapp)中开发的,并由外部审计师监督。
    结果:我们建议成人GERD患者的后部部分胃底折叠术优于全部后部或前部90°胃底折叠术。我们建议前路>90°胃底折叠术作为替代方法,尽管相关比较证据有限(弱推荐).准则,有建议,用户友好格式的证据摘要和决策辅助工具也可以在MAGICapp中访问:https://app。magicapp.org/#/guideline/j20X4n。
    结论:该快速指南是根据最高方法学标准制定的,并提供了关于GERD手术治疗的循证建议。它提供用户友好的决策辅助工具,以告知医疗保健专业人员和患者的决策。
    There are several options for the surgical management of GERD in adults. Previous guidelines and systematic reviews have compared the effects of total fundoplication versus pooled effects of different techniques of partial fundoplication.
    To develop evidence-informed, trustworthy, pertinent recommendations on the use of total, posterior partial and anterior partial fundoplications for the management of GERD in adults.
    We performed an update systematic review, network meta-analysis, and evidence appraisal using the GRADE and the Confidence in Network Meta-Analysis methodologies. An international, multidisciplinary panel of surgeons, gastroenterologists, and a patient representative reached unanimous consensus through an evidence-to-decision framework to select among multiple interventions, and a Delphi process to formulate the recommendation. The project was developed in an online authoring and publication platform (MAGICapp), and was overseen by an external auditor.
    We suggest posterior partial fundoplication over total posterior or anterior 90° fundoplication in adult patients with GERD. We suggest anterior >90° fundoplication as an alternative, although relevant comparative evidence is limited (weak recommendation). The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/j20X4n.
    This rapid guideline was developed in line with highest methodological standards and provides evidence-informed recommendations on the surgical management of GERD. It provides user-friendly decision aids to inform healthcare professionals\' and patients\' decision making.
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  • 文章类型: Editorial
    暂无摘要。
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