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1GRADE指南:Ⅰ.导论--GRADE证据概要表和结果总结表显示文摘本文是GRADE(Grading of Recommendations Assessment,Development,and Evaluation)系列文章的导论。该系列文章为使用GRADE系统提供指导,介绍如何将该系统用于系统评价、卫生技术评估(HTAs)及临床实践指南中备选方案的证据质量评价和推荐强度评级。GRADE方法始于提出一个明晰的问题,包括对所有重要结果的详细说明。证据被收集和汇总后,GRADE提供了明确的标准来评价其质量,包括研究设计、偏倚风险、不精确性、不一致性、间接性及效应量大小。根据支撑证据质量及备选方案带来的预期和非预期结果间的平衡情况,推荐强度以强/弱(或表述为'有条件的'/'任意的')作为特征。GRADE建议用简洁、透明、信息量丰富的结果总结表来汇总证据(以显示证据质量及每一重要结果的相对效应量和绝对效应量),和(或)以证据概要表形式额外提供证据质量评价理由的详细信息。本系列的后续文章涉及如何采用GRADE方法明确构建问题、评价证据质量及形成推荐意见。Gordon Guyatt Andrew D.Oxman Elie Akl Regina Kunz Gunn Vist Jan Brozek Susan Norris Yngve Falck-Ytter Paul Glasziou Hans deBeer Roman Jaeschke David Rind Joerg Meerpohl Philipp Dahm Holger J.Schünemann GRADE工作组 李幼平 杨晓妍 蒋兰慧 沈建通 2011中国循证医学杂志2011,11,4:205
2GRADE指南:Ⅲ.证据质量分级显示文摘本文介绍证据质量分级的GRADE方法。GRADE将证据质量分为高、中、低和极低四个级别。该分级应用于证据群,而非针对个别研究。系统评价中,质量反映了我们认为效应估计值正确的把握度。对推荐意见而言,质量反映了我们认为效应估计值足以支持某特定推荐的把握度。随机对照试验初定为高质量证据,观察性研究初定为低质量证据。GRADE中所使用的质量一词不只是意味着偏倚风险,还可能受研究结果的不精确性、不一致性和间接性,及发表偏倚的影响。此外,若干因素可增加我们对效应估计值的把握度。GRADE提供了一种系统方法来思考并报告各因素。GRADE将评估证据质量的过程与给出推荐建议的过程分开。推荐强度的判断不仅依赖于证据质量。Howard Balshem Mark Helfanda Holger J.Schunemann Andrew D.Oxman Regina Kunz Jan Brozek Gunn E.Vist Yngve Falck-Ytter Joerg Meerpohl Susan Norris Gordon H.Guyatt GRADE工作组 李幼平 杨晓妍 高霑 2011中国循证医学杂志2011,11,4:128
3GRADE在系统评价中应用的必要性及注意事项显示文摘本文通过具体实例分析了为何需要在系统评价中应用GRADE分级的原因,以及在使用过程中可能存在的误区与注意事项,主要包括:如何区分指南和系统评价中GRADE的不同应用,如何确定总的证据质量分级,是否应对单个研究进行分级,RCT和观察性研究分级的差异,分级条目权重的考虑,升降级级数的考虑和可能影响GRADE分级结果的因素,以期为正确理解和应用GRADE分级提供一定参考。陈耀龙 姚亮 Susan Norris 杜亮 陈昊 曾宪涛 毛智 杨克虎 2013中国循证医学杂志2013,13,12:136
4GRADE指南:Ⅶ.证据质量评价--不一致性显示文摘本文针对二分类变量结局指标相对(而非绝对)治疗效果的不一致性。证据本身不会因不同研究结果具有一致性而升级,但可能因不一致而降低质量级别。衡量一致性的标准包括点估计值的相似性、可信区间的重叠程度以及统计学判定标准包括异质性检验和I2。系统评价作者应提出并检验少数几个与患者、干预措施、结局指标以及方法学相关的先验假设以探寻异质性来源。当不一致性很大且无法解释时,因不一致性而降低质量级别是恰当的,特别当某些研究显示有显著益处而其他显示无益甚至有害时(而非仅是疗效大与疗效小的比较)。明显的亚组效应可能不可靠。如果亚组效应满足以下条件,其可信度将会增加:基于少数几个有具体方向的先验假设、亚组比较来自研究内而非研究间、交互检验的P值小、结果有生物学意义。Gordon H.Guyatt Andrew D.Oxman Regina Kunz James Woodcock Jan Brozek Mark Helfand Pablo Alonso-Coello Paul Glasziou Roman Jaeschke Elie A.Akl Susan Norris Gunn Vist Philipp Dahm Vijay K.Shukla Julian Higgins Yngve Falck-Ytter Holger J.Schünemann 代表GRADE小组 李幼平 杨晓妍 王莉 蔡羽嘉 陈群飞 2011中国循证医学杂志2011,11,12:33
5GRADE指南:Ⅷ.证据质量评价--间接性显示文摘直接证据来自直接比较我们关注的干预措施用于我们关注的患者人群,并测量患者重要结局的研究。间接证据可由以下4种方式之一产生。第一,患者可能与我们关注的患者不同(适用性一词常用于这类间接性)。第二,所检验的干预措施可能与我们关注的干预措施不同。有关患者和干预措施间接性的决策取决于对生物或社会因素差异是否大到可能使效应尺度出现预期的较大差异的考虑。第三,结果可能有别于最初设定的结局指标——如替代结果本身不重要,但测量之是基于替代结果的变化反映患者重要结局变化这一假设。第四类间接性在概念上与前三类不同,发生于临床医生必须在未经直接比较的两种干预措施间做出选择时。这种情况下比较治疗方案需要特定的统计方法,并根据患者人群、联合干预措施、结局测量指标及备选干预措施试验方法的差异程度,将证据级别降低1或2级。Gordon Guyatt Andrew D.Oxman Regina Kunz James Woodcock Jan Brozek Mark Helfand Pablo Alonso-Coello Yngve Falck-Ytter Roman Jaeschke Gunn Vist Elie A.Akl Piet N Post Susan Norris Joerg Meerpohl Mona Nasser 代表GRADE工作组 李幼平 杨晓妍 李鸿浩 2011中国循证医学杂志2011,11,12:30
6指南2.0:为成功制定指南而系统研发的全面清单显示文摘背景虽然当前已有一些评估卫生保健指南可靠性的工具,但仍缺乏针对制定指南实际步骤的指导。针对指南制定者们所需考虑的相关资源和工具,我们系统研发了一份全面的条目清单,但这并不意味着每篇指南都需遵守该清单的所有条目。方法我们检索了国际指南制定机构的指南制定手册、指南的指南(主要是来自国际和国家机构以及专业学会的方法学报告),以及提供系统指导的最新文章。经过反复评价这些资料,尽可能全面地罗列和提取条目,并制定与指南有关的重要主题。通过反复讨论,我们对条目进行评价以去重和补漏,同时邀请指南制定专家对所增加的条目进行修改并提出建议。结果我们制定了一份包含18个主题、146个条目的清单,并建立了帮助指南制定者应用这些条目的网站。这些主题和条目涵盖了指南从规划、完成、实施和评估的全过程。最终的清单版本也包括了培训所需的资料以及应用这些条目时用到的方法学参考文献的链接。解释本清单将提供给指南制定者用作参考。仔细考虑清单中的条目将有助于指南的制定、实施和评估,我们也将会通过大众反馈来修订并持续更新清单。Holger J. Schunemann Wojtek Wiercioch Itziar Etxeandia Maicon Falavigna Nancy Santesso Reem Mustafa Matthew Ventresca Romina Brignardello-petersen] Kaja-Triin Laisaar Sergio Kowalski Tejan Baldeh Yuan Zhang Uiia Raid Ignacio Neumann Susan L. Norris Judith Thornton Robin Harbour Shaun Treweek Gordon Guyatt Pablo Alonso-Coello Marge Reinap Jan Brozek Andrew Oxman Elie A. Akl 2014中国循证医学杂志2014,14,9:26
7意见不一致时的策略:应用GRADE网格对临床实践指南达成共识显示文摘指南制定委员会的结构庞大和多元化使达成共识变得困难。Roman Jaeschke及其同事阐述了一种达成共识的简单方法,即当无法取得一致时,应用GRADE网格对临床实践指南达成共识。Roman Jaeschke Gordon H Guyatt Phil Dellinger Holger Schünemann Mitchell M Levy Regina Kunz Susan Norris Julian Bion 刘芳 陈耀龙 2009中国循证医学杂志2009,9,7:22
8GRADE指南:Ⅸ.证据质量升级显示文摘证据质量升级的最常见原因是效应量大。当方法学严谨的观察性研究表明风险至少降低或增加2倍时,GRADE建议考虑将证据质量升高1级;当风险至少降低或增加5倍时,考虑将证据质量升高2级。当存在剂量-反应关系,或所有合理的混杂、偏倚会降低明显的治疗效应,或混杂、偏倚使得结果无效为假效应时,系统评价作者和指南制定者也可考虑升高证据质量。其他考虑因素包括起效迅速、潜在的疾病(状态)趋势以及间接证据。Gordon H.Guyatt Andrew D.Oxman Shahnaz Sultan Paul Glasziou Elie A.Akl Pablo Alonso-Coello David Atkins Regina Kunz Jan Brozek Victor Montori Roman Jaeschke David Rind Philipp Dahm Joerg Meerpohl Gunn Vist Elise Berliner Susan Norris Yngve Falck-Ytter M.Hassan Murad Holger J.Schünemann 代表GRADE工作组 李幼平 杨晓妍 李玲 王应强 2011中国循证医学杂志2011,11,12:22
9The Prevalence of HIV Drug Resistance among Treatment-failure Individuals and Treatment-nave Individuals in China:A Meta-analysis显示文摘Objective To understand drug resistance prevalence among treatment-failure and treatment-nave HIV-positive individuals in China.Methods We searched five electronic databases(Wanfang,CNKI,CQVIP,SinoMed,and Pubmed) for studies of HIV drug resistance.Random-effects models were carried out to estimate the prevalence of drug resistance among treatment-failure and treatment-nave individuals,respectively.Results The estimated nationwide rates of HIV drug resistance to any-class drugs among treatment-failure and treatment-nave individuals were 57%(95% CI:49%-65%) and 3.23%(95% CI:2.47%-4.07%),respectively.Among the drug classes,the prevalence of resistance to PIs was low(1.45%;95% CI:0.73%-2.33%) in treatment-failure individuals,although high rates of resistance to NNRTIs(54%;95% CI:45%-63%) and NRTIs(40%;95% CI:32%-49%) were found.Resistance to any-class drugs,NNRTIs and NRTIs manifested regional differences,but resistance to PIs did not.Positive correlations were observed between resistance to NNRTIs and NRTIs among treatment-failure and treatment-nave individuals,respectively.Conclusion The prevalence of HIV drug resistance to NNRTIs and NRTIs among treatment-failure individuals was high.In contrast,the prevalence of drug resistance among treatment-nave individuals was low.The epidemics of drug resistance matched current treatment strategies and interventions in China.Surveillance for HIV drug resistance is necessary to assess the sustainability and durability of current treatment regimens.WU Jing NORRIS Jessie LIU Hui Xin LI Zheng SU Ying Ying ZHU Lin WANG Ning 2014Biomedical and Environmental Sciences2014,27,11:17
10中国临床实践指南:现状、挑战和机遇显示文摘临床实践指南(以下简称“指南”)是基于系统评价证据,平衡了不同干预措施利弊,在此基础上形成的能为患者提供最佳医疗保健的推荐意见。相比其他国家,指南对中国卫生保健事业的发展和医疗质量的提升尤为重要,这是因为:第一,中国作为全世界人口最多的国家,通过指南来实施具有成本效果的医疗干预措施和医疗保健策略,陈耀龙 王辰 商洪才 杨克虎 Susan L Norris 2018英国医学杂志中文版2018,21,2:8
11PhERF2,an ethylene-responsive element binding factor,plays an essential role in waterlogging tolerance of petunia显示文摘Ethylene-responsive element binding factors(ERFs)are involved in regulation of various stress responses in plants,but their biological functions in waterlogging stress are largely unclear.In this study,we identified a petunia(Petunia×hybrida)ERF gene,PhERF2,that was significantly induced by waterlogging in wild-type(WT).To study the regulatory role of PhERF2 in waterlogging responses,transgenic petunia plants with RNAi silencing and overexpression of PhERF2 were generated.Compared with WT plants,PhERF2 silencing compromised the tolerance of petunia seedlings to waterlogging,shown as 96%mortality after 4 days waterlogging and 14 days recovery,while overexpression of PhERF2 improved the survival of seedlings subjected to waterlogging.PhERF2-RNAi lines exhibited earlier and more severe leaf chlorosis and necrosis than WT,whereas plants overexpressing PhERF2 showed promoted growth vigor under waterlogging.Chlorophyll content was dramatically lower in PhERF2-silenced plants than WT or overexpression plants.Typical characteristics of programmed cell death(PCD),DNA condensation,and moon-shaped nuclei were only observed in PhERF2-overexpressing lines but not in PhERF2-RNAi or control lines.Furthermore,transcript abundances of the alcoholic fermentation-related genes ADH1-1,ADH1-2,ADH1-3,PDC1,and PDC2 were reduced in PhERF2-silenced plants,but increased in PhERF2-overexpressing plants following exposure to 12-h waterlogging.In contrast,expression of the lactate fermentation-related gene LDH was up-regulated in PhERF2-silenced plants,but downregulated in its overexpressing plants.Moreover,PhERF2 was observed to directly bind to the ADH1-2 promoter bearing ATCTA motifs.Our results demonstrate that PhERF2 contributes to petunia waterlogging tolerance through modulation of PCD and alcoholic fermentation system.Dongmei Yin Daoyang Sun Zhuqing Han Dian Ni Ayla Norris Cai-Zhong Jiang 2019Horticulture Research2019,6,1:6
12Competing models of entrepreneurial intentions显示文摘Norris F. Krueger Michael D. Reilly Alan L. Carsrud 2000Journal of Business Venturing2000,,5:3
13Herpes Simplex Virus Type 2 Risks in Female Sex Workers in the China-vietnam Border County of Hekou显示文摘Objective To survey the prevalence and risk factors of HSV-2 among Chinese and Vietnamese female sex workers (FSW) in the border county of Hekou, Yunnan Province, China. Methods A cross-sectional survey was conducted on demographics, sexual behavior, medical history, and drug use among FSWs. Laboratory samples were obtained to test for HSV-2 and other STIs such as HIV, Syphilis, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Bacterial vaginosis, and Yeast infections. Cervicitis and genital warts were also diagnosed. Results Of the 345 FSWs who participated in this study, 112 (32.5%) were ethnic Chinese and 233 (67.5) were Vietnamese. Among FSWs in Hekou, the prevalence rates were 58.3% for HSV-2, 5.5% for HIV, and 4.1% for bacterial vaginosis (BV). Age <21 (OR: 0.5; 95% CI: 0.3, 0.8), duration of commercial sex work ≤3 months (OR: 0.5; 95% CI: 0.3, 0.8), oral and vaginal sex with the last client (as opposed to only vaginal sex) (OR: 1.6; 95% CI: 1.0, 2.7), HIV (OR: 11.4; 95% CI: 1.5, 87.2), and bacterial vaginosis (BV) (OR: 5.6; 95% CI: 1.2, 26.9) were significantly correlated with HSV-2 infection. Conclusion Multivariate analysis showed that several factors were significantly correlated with the high prevalence of HSV-2 in FSWs in the border area between China and Vietnam. Further studies and interventions are needed for HSV-2 epidemiology in the border area.WANG Jun Jie ZHU Zhi Bin YANG Xi WU Jing WANG Hai BO FENG Lin DING Guo Wei Jessie L. NORRIS WANG Ning 2012Biomedical and Environmental Sciences2012,25,6:3
14Diel and seasonal patterns of variation in the singing behaviour of Savannah Sparrows (Passerculus sandwichensis)显示文摘Background:The vocalizations of birds are dynamic traits that often vary in output with time of day and time of year.By quantifying patterns of diel and seasonal variation in vocal output,we can gain insight into the ecology and evolution of birds and the function of their vocalizations.In this investigation,we quantified diel and seasonal variation in song output by studying a breeding population of Savannah Sparrows (Passerculus sandwichensis).Methods:We used autonomous recorders to collect extensive recordings across the breeding season in a long-term, colour-marked study population of Savannah Sparrows in eastern Canada.We described diel and seasonal variation across five different breeding stages based on recordings of more than 50,000 songs from 34 males.Results:During the pre-breeding stage, prior to female arrival, males sang a pronounced dawn chorus with a peak in song output during the early morning.During the breeding stage,in contrast,the dawn chorus was diminished and males instead exhibited a pronounced dusk chorus with a peak in song output during the evening.Across the breeding season,the highest levels of song output occurred in late April and early May,soon after males arrived on the breeding grounds,and the lowest levels occurred in August,prior to the departure of birds for the wintering grounds.Conclusions:These patterns suggest that Savannah Sparrows' early-season dawn choruses are directed at males and serve a territorial defense function.Later-season dusk choruses,in contrast, appear to play a role in attracting mates and possibly acoustic mate guarding.Ines G.Moran Katrina C.Lukianchuk Stephanie.M.Doucet Amy E.M.Newman Heather Williams D.Ryan Norris Daniel J.Mennill 2019Avian Research2019,10,3:3
15CpG Island methylation in sporadic colorectal cancers and its relationship to microsatellite instability显示文摘Nicholas Hawkins Mark Norrie Kay Cheong Elisa Mokany Su-Lyn Ku Alan Meagher Terence O’connor Robyn Ward 2002Gastroenterology2002,,:2
16Three-Dimensional Imaging of Single Molecules Solvated in Pores of Poly (acrylamide)Gels 显示文摘Dickscn R M Norris D J Tzeng Y-L 1996Science1996,274,:2
17Health-related attitudes and risk factors for sexually transmitted infections of Chinese women who have sex with women显示文摘WANG Xiao-fang Jessie L. Norris LIUYingjie Kathleen H. Reilly WANG Ning 2012Chinese Medical Journal2012,,16:2
18Increasing diabetes self-management education in community settings显示文摘Susan L Norris Phyllis J Nichols Carl J Caspersen Russell E Glasgow Michael M Engelgau Leonard Jack Susan R Snyder Vilma G Carande-Kulis George Isham Sanford Garfield Peter Briss David McCulloch 2002American Journal of Preventive Medicine2002,,4:2
19Carotid Plaque Pathology: Thrombosis, Ulceration, and Stroke Pathogenesis显示文摘Mark Fisher Annlia Paganini-Hill Aldana Martin Michele Cosgrove James F. Toole Henry J.M. Barnett John Norris 2005Stroke2005,,2:2
20An investigation of functional and anatomical connectivity using magnetic resonance imaging显示文摘Koch M A Norris D G Hund-Georgiadis M 2002NeuroImage2002,16,:2
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