基于AGREEⅡ的成人癌症营养实践指南质量评价
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摘要
目的对国内外近5年成人癌症营养实践指南进行质量评价,分析近年来癌症营养领域实践指南现状,并甄别出高质量指南供我国临床医护人员参考。方法系统检索数据库、指南网站和专业学会网站近5年成人癌症营养实践指南,采用AGREEⅡ对符合纳入、排除标准的指南进行质量评价。结果纳入成人癌症营养指南共20篇,A级推荐2篇,B级推荐11篇,C级推荐7篇;20篇指南在AGREEⅡ6大领域的平均标准化得分分别为清晰性85.09%、范围和目的77.13%、严谨性52.64%、参与人员41.11%、独立性29.44%、应用性21.46%。结论近5年的成人癌症营养指南的总体方法学质量一般,高质量指南均为国外指南,我国的癌症营养指南质量有待进一步提高。
Objective To evaluate the methodological quality of clinical nutrition guidelines for adult cancer patients published natio-nally and internationally in recent five years, analyze the current status of clinical nutrition guidelines, and identify higher quality guidelines for China′s clinicians.Methods We systematically searched databases, websites of professional organizations and websites of clinical practice guidelines to retrieve clinical nutrition guidelines for adult cancer patients published in recent 5 years, and used AGREEⅡ to evaluate the chosen guidelines.Results A total of 20 nutrition guidelines for adult cancer patients were finally inclu-ded, 2 graded level A, 11 level B and 7 level C.The mean standardized scores of guidelines in six domains of AGREEⅡ were 77.13% in scope and purpose, 41.11% in stakeholder involvement, 52.64% in rigor of development, 85.09% in clarity of presentations, 21.46%in applicability and 29.44% in independence, respectively.Conclusion The overall methodological quality of the current clinical nutrition guidelines for adult cancer patients were generally low in quality. The high quality guidelines were from other countries, and the quality of cancer nutrition guidelines in China still needs to be improved.
Objective To evaluate the methodological quality of clinical nutrition guidelines for adult cancer patients published natio-nally and internationally in recent five years, analyze the current status of clinical nutrition guidelines, and identify higher quality guidelines for China′s clinicians.Methods We systematically searched databases, websites of professional organizations and websites of clinical practice guidelines to retrieve clinical nutrition guidelines for adult cancer patients published in recent 5 years, and used AGREEⅡ to evaluate the chosen guidelines.Results A total of 20 nutrition guidelines for adult cancer patients were finally inclu-ded, 2 graded level A, 11 level B and 7 level C.The mean standardized scores of guidelines in six domains of AGREEⅡ were 77.13% in scope and purpose, 41.11% in stakeholder involvement, 52.64% in rigor of development, 85.09% in clarity of presentations, 21.46%in applicability and 29.44% in independence, respectively.Conclusion The overall methodological quality of the current clinical nutrition guidelines for adult cancer patients were generally low in quality. The high quality guidelines were from other countries, and the quality of cancer nutrition guidelines in China still needs to be improved.
引文
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[16] SFNEP.Clinical nutrition guidelines of the French Spea-king Society of Clinical Nutrition and Metabolism (SFNEP):summary of recommendations for adults undergoing non-surgical anticancer treatment[J].Dig Liver Dis,2014,46(8):667-674.
[17] 中国抗癌协会肿瘤营养与支持治疗专业委员会.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015:1-320.
[18] 中华医学会肠外肠内营养学分会.肿瘤患者营养支持指南[J].中华外科杂志,2017,55(11):801-829.
[19] Isenring E, Zabel R, Bannister M, et al.Updated evidence-based practice guidelines for the nutritional ma-nagement of patients receiving radiation therapy and/or chemotherapy[J].Nutrition Dietetics,2013,70(4):312-324.
[20] 中华医学会肠外肠内营养学分会.成人围手术期营养支持指南[J].中华外科杂志,2016,54(9):641-657.
[21] Talwar B, Donnelly R, Skelly R, et al.Nutritional ma-nagement in head and neck cancer:United Kingdom National Multidisciplinary Guidelines[J].J Laryngol Otol,2016,130(2):32-40.
[22] Higashiguchi T, Ikegaki J, Sobue K, et al.Guidelines for parenteral fluid management for terminal cancer patients[J].Jpn J Clin Oncol,2016,46(11):1-7.
[23] 崔久嵬,卓文磊,黄岚,等.肿瘤免疫营养治疗指南[J].肿瘤代谢与营养电子杂志,2016,3(4):224-228.
[24] 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会癌症康复与姑息治疗专业委员会.口服营养补充指南[J].肿瘤代谢与营养电子杂志,2015,2(4):33-34.
[25] 石汉平.化疗患者营养治疗指南[J].肿瘤代谢与营养电子杂志,2016,3(3):158-163.
[26] 石汉平.结直肠癌营养治疗指南[J].肿瘤代谢与营养电子杂志,2016,3(3):164-165.
[27] 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会肿瘤康复与姑息治疗专业委员会.肺癌营养指南[J].肿瘤代谢与营养电子杂志,2016,3(1):34-36.
[28] 石汉平,李苏宜,王昆华,等.胃癌患者营养治疗指南[J].肿瘤代谢与营养电子杂志,2015,2(2):37-40.
[29] 中国抗癌协会肿瘤营养与支持治疗专业委员会.肌肉减少症营养治疗指南[J].肿瘤代谢与营养电子杂志,2015,2(3):32-36.
[30] 中国抗癌协会.肿瘤恶液质营养治疗指南[J].肿瘤代谢与营养电子杂志,2015,2(3):27-31.
[31] 周文华,李峥,史冬雷,等.2004～2014年预防中心静脉导管相关血行感染的指南评价[J].护理学杂志,2017,32(2):98-103.
[32] 颜美琼,李全磊,陆箴琦,等.PICC置管前评估的临床实践指南构建及AGREE评价[J].护理学杂志,2013,28(14):1-5.
[33] van den Berg T, Engelhardt E G, Haanstra T M, et al.Methodology of clinical nutrition guidelines for adult cancer patients:how good are they according to AGREE criteria?[J].J Parenter Enteral Nutr,2012,36(3):316-322.
[34] 林夏,杨克虎,陈耀龙,等.中国临床实践指南的现状与思考[J].中国循证医学杂志,2017,17(5):497-500.
[35] 石汉平.肿瘤营养学[M].北京:人民卫生出版社,2012:3-4.
[2] Cederholm T, Barazzoni R, Austin P, et al.ESPEN guidelines on definitions and terminology of clinical nutrition[J].Clin Nutr,2017,36(1):49-64.
[3] Baracos V E.Cancer-associated malnutrition[J].Eur J Clin Nutr,2018,72(9):1255-1259.
[4] 吴国豪.肿瘤患者的营养不良支持[J].中华普通外科学文献(电子版),2015,9(6):417-420.
[5] Trustworthy I O M U, Guidelines C P.Clinical practice guidelines we can trust[M].Washington (DC): National Academies Press (US),2011:11-12.
[6] 卫茂玲,刘鸣.中国临床指南循证制定的方法学现状分析[J].中国循证医学杂志,2013,13(8):927-932.
[7] Unwin N, Thomson R, O′Byrne A M, et al.Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors[J].BMJ,1998,317(7166):1125-1130.
[8] Zadvinskis I M, Grudell B A.Clinical practice guideline appraisal using the AGREE instrument: renal screening[J].Clin Nurse Spec,2010,24(4):209-214.
[9] 陈尹,胡世莲,李幼平,等.全球药物干预治疗单纯性高血压指南的系统评价[J].中国循证医学杂志,2012,12(10):1180-1194.
[10] 姚玮,朱彩蓉,罗映娟,等.用STATA软件包计算分类资料的Kappa统计量[J].现代预防医学,2010(4):615-616.
[11] Arends J, Bachmann P, Baracos V, et al.ESPEN guidelines on nutrition in cancer patients[J].Clin Nutr,2017,36(1):11-48.
[12] Care NLCFA.Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition[M].London: National Collaborating Centre for Acute Care (UK),2006:1-37.
[13] Weimann A, Braga M, Carli F, et al.ESPEN guideline: clinical nutrition in surgery[J].Clin Nutr,2017,36(3):623-650.
[14] McClave S A, DiBaise J K, Mullin G E, et al.ACG cli-nical guideline: nutrition therapy in the adult hospita-lized patient[J].Am J Gastroenterol,2016,111(3):315-335.
[15] Thompson K L, Elliott L, Fuchs-Tarlovsky V, et al.Oncology evidence-based nutrition practice guideline for adults[J].J Acad Nutr Diet,2017,117(2):297-310.
[16] SFNEP.Clinical nutrition guidelines of the French Spea-king Society of Clinical Nutrition and Metabolism (SFNEP):summary of recommendations for adults undergoing non-surgical anticancer treatment[J].Dig Liver Dis,2014,46(8):667-674.
[17] 中国抗癌协会肿瘤营养与支持治疗专业委员会.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015:1-320.
[18] 中华医学会肠外肠内营养学分会.肿瘤患者营养支持指南[J].中华外科杂志,2017,55(11):801-829.
[19] Isenring E, Zabel R, Bannister M, et al.Updated evidence-based practice guidelines for the nutritional ma-nagement of patients receiving radiation therapy and/or chemotherapy[J].Nutrition Dietetics,2013,70(4):312-324.
[20] 中华医学会肠外肠内营养学分会.成人围手术期营养支持指南[J].中华外科杂志,2016,54(9):641-657.
[21] Talwar B, Donnelly R, Skelly R, et al.Nutritional ma-nagement in head and neck cancer:United Kingdom National Multidisciplinary Guidelines[J].J Laryngol Otol,2016,130(2):32-40.
[22] Higashiguchi T, Ikegaki J, Sobue K, et al.Guidelines for parenteral fluid management for terminal cancer patients[J].Jpn J Clin Oncol,2016,46(11):1-7.
[23] 崔久嵬,卓文磊,黄岚,等.肿瘤免疫营养治疗指南[J].肿瘤代谢与营养电子杂志,2016,3(4):224-228.
[24] 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会癌症康复与姑息治疗专业委员会.口服营养补充指南[J].肿瘤代谢与营养电子杂志,2015,2(4):33-34.
[25] 石汉平.化疗患者营养治疗指南[J].肿瘤代谢与营养电子杂志,2016,3(3):158-163.
[26] 石汉平.结直肠癌营养治疗指南[J].肿瘤代谢与营养电子杂志,2016,3(3):164-165.
[27] 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会肿瘤康复与姑息治疗专业委员会.肺癌营养指南[J].肿瘤代谢与营养电子杂志,2016,3(1):34-36.
[28] 石汉平,李苏宜,王昆华,等.胃癌患者营养治疗指南[J].肿瘤代谢与营养电子杂志,2015,2(2):37-40.
[29] 中国抗癌协会肿瘤营养与支持治疗专业委员会.肌肉减少症营养治疗指南[J].肿瘤代谢与营养电子杂志,2015,2(3):32-36.
[30] 中国抗癌协会.肿瘤恶液质营养治疗指南[J].肿瘤代谢与营养电子杂志,2015,2(3):27-31.
[31] 周文华,李峥,史冬雷,等.2004～2014年预防中心静脉导管相关血行感染的指南评价[J].护理学杂志,2017,32(2):98-103.
[32] 颜美琼,李全磊,陆箴琦,等.PICC置管前评估的临床实践指南构建及AGREE评价[J].护理学杂志,2013,28(14):1-5.
[33] van den Berg T, Engelhardt E G, Haanstra T M, et al.Methodology of clinical nutrition guidelines for adult cancer patients:how good are they according to AGREE criteria?[J].J Parenter Enteral Nutr,2012,36(3):316-322.
[34] 林夏,杨克虎,陈耀龙,等.中国临床实践指南的现状与思考[J].中国循证医学杂志,2017,17(5):497-500.
[35] 石汉平.肿瘤营养学[M].北京:人民卫生出版社,2012:3-4.