《肛瘘中西医结合诊疗指南》临床问题与结局指标构建研究

BackgroundIn recent yearsstudies have found that the clinical effect of integrated traditional Chinese and Western medicine in the treatment of anal fistula is significantbut there is still a lack of more complete industry guidelines and standards for the diagnosis and treatment of anal fistula. Thereforeit is of great significance to formulate the Guidelines for the Diagnosis and Treatment of Anal Fistula with Integrated Traditional Chinese and Western Medicinein which the construction of clinical problems and outcome indicators is the key point to determine the quality of the guidelines.ObjectiveTo identify the clinical queries and outcome indicators of the Guidelines for the Diagnosis and Treatment of Anal Fistula with Integrated Chinese and Western Medicineand to provide a basis for the follow-up evidence-based evidence retrievalevidence grade evaluation and forming recommendations. MethodsFirstthrough literature researchexpert interviews and extensive clinical researchpreliminary sorting out clinical problems and outcome indicators. Thenon this basisthe Delphi method expert questionnaire is designed and two rounds of expert surveys are carried out. Excel 2021 and SPSS 26.0 software were used to statistically process the questionnaire resultsand the expert positive coefficientmeanfull score ratio and coefficient of variation of each clinical problem and outcome index were calculated for importance evaluation. Entries with average score 3 for clinical problemsaverage score 7 for outcome indicatorsfull score ratio 50%and coefficient of variation 0.7Cronbach's coefficients 0.7 were used for the quality control of Delphi questionnaire. ResultsAfter preliminary investigation26 clinical questions 7 basic questions and 19 PICO clinical questionsand 9 outcome indicators were formulated. After two rounds of Delphi method survey of 34 experts in related fields24 clinical questions7 basic questions and 17 PICO clinical questionsand 8 key outcome indicators were formed. The positive coefficients of experts in the two rounds of questionnaires were 100% and 91%the Kendall harmony coefficients were 0.722 and 0.852and the Cronbach's coefficients of clinical questions and outcome indicators were 0.9190.809 and 0.9350.746respectivelyindicating that experts paid high attention to this studysmall disagreementhigh degree of coordinationgood questionnaire reliability and high reliability of results. Finallyafter discussion among experts in the study group24 clinical questions7 basic questions and 17 PICO clinical questions were identified as included in the guidelines to form recommendations. ConclusionThrough literature researchexpert interviewsextensive clinical research and expert investigation of Delphi methodthe clinical problems and outcome indicators of the Guidelines for the Diagnosis and Treatment of Anal Fistula with Integrated Chinese and Western Medicine were determinedwhich laid the foundation for the subsequent formulation of the guidelinesand also provided a methodological reference for the construction of the core clinical problems and outcome indicators of the guidelines in the anorectal fieldand had certain reference significance for the formulation of evidence-based guidelines for traditional Chinese medicine.