Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.
Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.
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DOI：
10.1016/j.fertnstert.2018.05.004
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发表时间：
2018-08
影响因子：
6.7
通讯作者：
International PCOS Network
中科院分区：
文献类型：
--
作者：
Teede HJ;Misso ML;Costello MF;Dokras A;Laven J;Moran L;Piltonen T;Norman RJ;International PCOS Network
根据现有最佳证据、临床专业知识和消费者偏好，建议对多囊卵巢综合征（PCOS）女性进行哪些评估和管理？国际循证指南包括166项建议和实践要点，解决了优先考虑的问题，以促进一致的循证护理，改善PCOS妇女的经验和健康结果。以前的指南要么缺乏严格的循证过程，要么没有吸收消费者和国际多学科的观点，要么已经过时。PCOS的诊断仍然存在争议，评估和管理不一致。PCOS妇女的需求没有得到充分满足，证据实践差距仍然存在。国际循证指南的制定涉及专业协会和消费者组织，多学科专家和PCOS妇女直接参与所有阶段。遵循了研究和评价准则（AGREE）II的评估程序，并进行了广泛的证据综合。建议、评估、开发和评价（GRADE）框架的分级适用于证据质量、可行性、可接受性、成本、实施和最终建议强度。管理包括一个六大洲国际咨询和一个项目委员会，五个准则制定小组，以及消费者和翻译委员会。广泛的卫生专业人员和消费者参与为指南的范围和优先事项提供了信息。国际社会提名的专家小组包括儿科、内分泌学、妇科、初级保健、生殖内分泌学、产科、精神病学、心理学、营养学、运动生理学、公共卫生和其他专家，以及消费者、项目管理、证据合成和翻译专家。71个国家的37个协会和组织参与了这一进程。在15个月的时间里，20次面对面会议讨论了60个优先考虑的临床问题，涉及40个系统性审查和20个叙述性审查。基于证据的建议是通过五个指南小组的一致投票制定和批准的，根据国际反馈和同行评审进行修改，最终建议在所有小组中获得批准。多囊卵巢综合征评估和管理的证据质量通常为低至中等。该指南提供了31个循证建议，59个临床共识建议和76个临床实践点，所有这些都与PCOS的评估和管理有关。该指南的主要变化包括：i）对个人诊断标准进行了相当大的改进，重点是提高诊断的准确性; ii）减少不必要的测试; iii）更加关注教育，生活方式的改变，情绪健康和生活质量; iv）强调循证医学治疗和更便宜，更安全的生育管理。总体证据质量通常较低至中等，需要对这种被忽视但常见的疾病进行更多的研究，特别是围绕完善多囊卵巢综合征的特定诊断特征。区域卫生系统的差异得到承认，并提供了一个指导方针和翻译资源适应的过程。PCOS评估和管理的国际指南为临床医生提供了基于最佳证据，专家多学科输入和消费者偏好的最佳实践的明确建议。研究建议已经产生，并且一个全面的多方面传播和翻译计划通过综合评估计划支持该指南。该指南主要由澳大利亚国家健康和医学研究理事会（NHMRC）资助，并得到ESHRE和美国生殖医学会的合作支持。指导方针制定小组成员没有收到报酬。旅费由赞助组织支付。利益冲突的披露在一开始就被宣布，并在整个指南过程中进行更新，与NHMRC指南过程保持一致。在指南开发组中声明的冲突的全部细节可在利益披露登记册中的https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline上获得。在指定的作者中，Costello博士已经宣布了Virtus Health的股份，以及默克雪兰诺过去对会议演讲的赞助。Laven教授申报了来自Ferring，Euroscreen的赠款以及来自Ferring，Euroscreen，Danone和Titus Healthcare的个人费用。诺曼教授宣布了一个试管婴儿单位的小股东权益。其余的作者没有利益冲突。该指南由我们的合作伙伴和合作协会以及消费者组织的特殊利益集团进行了同行评审，并根据ECOMEII标准进行了独立评估，并进行了方法审查。该指南已获得指南制定小组所有成员的批准，并提交NHMRC进行最终批准
What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; ii) reducing unnecessary testing; iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREEII criteria and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC
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影响因子：
13.3
作者：
Balen, Adam H.;Morley, Lara C.;Teede, Helena
通讯作者：
Teede, Helena
影响因子：
81.5
作者：
Azziz, Ricardo;Carmina, Enrico;Yildiz, Bulent O.
通讯作者：
Yildiz, Bulent O.
DOI：
10.1210/jc.2013-2350
发表时间：
2013-12
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Legro RS;Arslanian SA;Ehrmann DA;Hoeger KM;Murad MH;Pasquali R;Welt CK;Endocrine Society
通讯作者：
Endocrine Society
影响因子：
6.7
作者：
Dokras, Anuja;Saini, Shailly;Teede, Helena
通讯作者：
Teede, Helena
影响因子：
5.8
作者：
Teede, Helena;Gibson-Helm, Melanie;Boyle, Jacqueline
通讯作者：
Boyle, Jacqueline