Guidelines as Topic ; Pharmacoepidemiology ; Reference Standards

Guidelines as Topic ; Humans ; Medical Oncology ; standards ; Neoplasms

Child ; Documentation ; standards ; Humans ; Pediatrics ; standards ; Practice Guidelines as Topic

Carcinoma, Intraductal, Noninfiltrating ; therapy ; Humans ; Lymphoma ; therapy ; Periodicals as Topic ; standards ; Practice Guidelines as Topic ; standards ; Publishing ; standards

Acupuncture Therapy ; methods ; standards ; Guidelines as Topic ; Humans ; Randomized Controlled Trials as Topic ; methods ; standards ; Research Design ; standards

Asthma ; diagnosis ; therapy ; China ; Humans ; Practice Guidelines as Topic ; standards

China ; Humans ; Lymphoma ; diagnosis ; Practice Guidelines as Topic ; standards

China ; Humans ; Lung Neoplasms ; diagnosis ; therapy ; Practice Guidelines as Topic ; standards

BACKGROUNDClinical practice guidelines (CPGs) play an important role in healthcare in China as well as in the world. However, the current status and trends of Chinese CPGs are unknown. The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature.

METHODSTo identify Chinese CPGs, a systematic search of relevant literature databases (CBM, WANFANG, VIP, and CNKI) was performed for the period January 1978 to December 2010. We used the AGREE II instrument to assess the quality of the included guidelines.

RESULTSWe evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256 different developers. Only four guidelines (1%) described the systematic methods for searching and selecting the evidence, 14 (5%) guidelines indicated an explicit link between the supporting evidence and the recommendations, only one guideline used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Thirty-one guidelines (12%) mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline. From the assessment with the Appraisal of Guidelines for Research and Ecaluation II (AGREE II), the mean scores were low for the domains "scope and purpose" (19%) and "clarity of presentation" (26%) and very low for the other domains ("rigour of development" 7%, "stakeholder involvement" 8%, "applicability" 6% and "editorial independence" 2%).

CONCLUSIONSCompared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries, Chinese CPGs received lower scores, which indicates a relatively poor quality of the guidelines. However, there was some increase over time.

INTRODUCTIONPaediatric sepsis is a global health problem. It is the leading cause of mortality in infants and children worldwide. Appropriate and timely initial management in the first hours, often termed as the "golden hours", has great impact on survival. The aim of this paper is to summarise the current literature and updates on the initial management of paediatric sepsis.

MATERIALS AND METHODSA comprehensive literature search was performed via PubMed using the search terms: 'sepsis', 'septic shock', 'paediatric' and 'early goal-directed therapy'. Original and review articles were identified and selected based on relevance to this review.

RESULTSEarly recognition, prompt fluid resuscitation and timely administration of antibiotics remain key in the resuscitation of the septic child. Use of steroids and tight glycaemic control in this setting remain controversial.

CONCLUSIONThe use of early goal-directed therapy has had significant impact on patient outcomes and protocolised resuscitation of children in septic shock is recommended.