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：
10.1111/cen.13795
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发表时间：
2018-09-01
影响因子：
3.2
通讯作者：
Norman, Robert J.
中科院分区：
文献类型：
--
作者：
Teede, Helena J.;Misso, Marie L.;Norman, Robert J.
研究问题：根据现有的最佳证据、临床专业知识和消费者偏好，对多囊卵巢综合征（PCOS）女性的评估和管理建议是什么？国际循证指南包括166项建议和实践要点，解决了优先问题，以促进一致的循证护理，改善多囊症妇女的经历和健康结果。以前的指南要么缺乏严格的循证程序，要么没有考虑到消费者和国际多学科的观点，要么已经过时。多囊卵巢综合征的诊断仍有争议，评估和管理不一致。多囊卵巢综合征妇女的需求没有得到充分满足，证据实践差距仍然存在。研究设计、规模、持续时间国际循证指南的制定有多学科专家和多囊卵巢综合征妇女直接参与的专业协会和消费者组织参与。遵循了研究和评估指南（AGREE） ii合规流程的评估，并进行了广泛的证据合成。建议、评估、发展和评价分级（GRADE）框架应用于证据质量、可行性、可接受性、成本、实施和最终建议强度。参与者/材料、设置、方法治理包括一个六大洲的国际咨询和项目委员会、五个指南制定小组（gdg）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学、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。覆盖71个国家的37个学会和组织参与了这一进程。超过15个月的20次面对面会议解决了60个优先临床问题，涉及40个系统回顾和20个叙述性回顾。基于证据的建议是通过五个指导小组的共识投票制定和批准的，根据国际反馈和同行评审进行修改，最终建议得到所有小组的批准。PCOS评估和治疗的证据质量一般为中低水平。该指南提供了31项循证建议、59项临床共识建议和76项临床实践要点，均与多囊卵巢综合征的评估和管理有关。本指南的主要变化包括：(a)对个别诊断标准进行了相当大的改进，重点是提高诊断的准确性；(b)减少不必要的检测；(c)增加对教育、改变生活方式、情绪健康和生活质量的关注；(d)强调以证据为基础的医疗和更便宜、更安全的生育管理。总的来说，证据通常是低到中等质量的，需要对这种被忽视但常见的疾病进行更多的研究，特别是在完善PCOS的具体诊断特征方面。承认区域卫生系统的差异，并提供了指南和翻译资源适应的过程。研究结果的更广泛意义多囊卵巢综合征评估和管理的国际指南为临床医生提供了基于最佳现有证据、多学科专家意见和消费者偏好的最佳实践的明确建议。已经提出了研究建议，一个全面的、多方面的传播和翻译项目通过一个综合评价项目来支持该指南。
Study QuestionWhat is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference?Summary AnswerInternational 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.What is Known AlreadyPrevious 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rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated.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.Study Design, Size, DurationInternational 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.Participants/Materials, Setting, MethodsGovernance included a six continent international advisory and a project board, five guideline development groups (GDGs), 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 15months 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.Main Results and the Role of ChanceThe 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: (a) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (b) reducing unnecessary testing; (c) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (d) emphasizing evidence based medical therapy and cheaper and safer fertility management.Limitations, Reasons for CautionOverall 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.Wider Implications of the FindingsThe 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.