《痔中西医结合诊疗指南》临床问题与结局指标的收集与确定

Background  Hemorrhoids are the most common diseases in the anorectal departmentwith a large patient population. The clinical integrated diagnosis and treatment of traditional Chinese and Western medicine has obvious advantages. Currentlythere is a lack of relevant high-quality guidelines or recommended standards. Standardizing the integrated diagnosis and treatment of hemorrhoids with traditional Chinese and Western medicine is of great significance.Objective  To screen and define the core clinical issues and outcome indicators of Guidelines for the Integrated Diagnosis and Treatment of HemorrhoidsHemorrhoids and Western Medicine and Traditional Chinese Medicine Combinedand to provide support for subsequent evidence integration and guideline writing. Methods  A preliminary list of questions was formed through literature analysisexpert interviewsand clinical research. Two rounds of expert consultation were conducted using the Delphi method. Data analysis was performed using SPSS Statistics 26 and Excel 2021. Positive coefficientsmean valuesfull score ratescoefficient of variationand Cronbach's values were calculated. Inclusion criteria wereclinical issue mean score 3 pointsoutcome indicator mean score 7 pointsfull score rate 50%and coefficient of variation 0.7and Cronbach's 0.7 as the quality control standard for the Delphi questionnaire. Results  After preliminary investigation27 clinical issues9 basic issues and 18 PICO based clinical issuesand 9 outcome indicators were formulated. After two rounds of Delphi method surveys among 34 experts in related fields28 clinical issues9 basic issues and 19 PICO-based clinical issuesand 9 key outcome indicators were formed. The positive coefficients of the two rounds of questionnaires were 85% and 97%respectively. The Kendall's harmony coefficients were 0.837 and 0.826respectively. The Granger coefficients of each item of clinical issues and outcome indicators were 0.9290.8660.923and 0.803respectively. This indicates that experts have high attention to this studysmall differenceshigh coordinationgood questionnaire reliabilityand high result reliability. Finallyafter discussion among the experts in the research group28 clinical issues9 basic issues and 19 PICO-based clinical issueswere determined to be included in the guideline. The clinical issues cover the characteristics of traditional Chinese medicine in hemorrhoidspreoperative assessmentintegrated diagnosis and treatment methods of Western medicine and traditional Chinese medicineand perioperative managementetc. Conclusion  The clinical issues and outcome indicator system established based on multi-dimensional research and the Delphi method provides a scientific framework for guideline compilationhighlighting the importance of multi-disciplinary consensus in the formulation of integrated medical guidelines.