BACKGROUND:Although guidelines focus predominantly on individual diseases, some dedicated guidelines and recommendations exist for common combinations of comorbidities. Using diabetes, coronary heart disease (CHD) and stroke as an example, we aimed to assess the current status and quality of such guidelines. METHODS:We systematically searched literature databases, Google, guideline platforms, and websites of relevant organizations. We included guidelines published between 2020 and 2024 that addressed at least two of the following diseases: diabetes, CHD, and stroke; and included drug therapy interventions. We extracted the recommendations on drug therapy and sources of the supporting evidence, and assessed the quality of the guidelines using AGREE II and RIGHT with the help of a large language model based tool. RESULTS:We identified 82 guidelines: 64 focused on one disease with recommendations on comorbidities, and 18 specifically addressed a combination of diseases. China was the most frequent country of origin (n = 50, 61.0%). The methodological and reporting quality of these guidelines was moderate on average. For most guidelines (n = 54, 65.9%), the primary focus was on diabetes. We grouped the recommended drug therapies for patients with combinations of these diseases into four main categories: anti-diabetic therapy, antihypertensive therapy, lipid-lowering therapy, and anticoagulant therapy. Most recommendations were supported by RCTs, but only a third of the guidelines referred to studies done in multimorbid patients. CONCLUSION:Most recommendations related to multimorbidity were found in guidelines focusing on a single target disease, and supporting evidence from multimorbid patients was rare. More primary evidence from multimorbid patients is needed.

BACKGROUND:The management of multimorbidity often requires applying multiple disease-specific guidelines, which may lead to harmful disease and drug interactions. The objective of the study was to collect the opinions of leading experts on factors influencing the use of guidelines in decision-making in multimorbidity management from a multidisciplinary perspective, and provide empirical insights to inform guideline-based decision support. METHODS:We conducted a series of semi-structured interviews with experts in multimorbidity research and practice and guideline development to participate. Interviewees were selected using purposive sampling. Our interviews covered the current use of clinical guidelines in multimorbidity management, key barriers and facilitators, and priority action areas. Thematic analysis was performed using NVivo 12.0. RESULTS:Fifteen experts from nine countries were interviewed. The lack of multimorbidity-specific guidelines and recommendations may lead healthcare providers to either rely solely on personal experience, or follow guidelines without considering the needs and comorbidities of individual patients. Major barriers to guideline application include insufficient evidence and limited awareness and training among clinicians in both multimorbidity management and guideline implementation. The interviewees emphasized flexible use of guidelines, prioritizing patient values and preferences, and individualized management goals informed by (rather than strictly adhering to) guidelines. CONCLUSIONS:Applying guidelines in multimorbidity care faces major evidence and applicability gaps. Particularly the generation of high-quality clinical evidence specific to multimorbidity, enhancing the methodological rigor in guideline development, and improvement of the contextual relevance and usability of guidelines in real-world settings need more attention.

Abstract Background Despite the growing global burden of multimorbidity, the patterns of disease combinations, have not been extensively categorized. We aimed to explore the predictors, health consequences, and patterns of discordant and concordant multimorbidity. Methods We used the 2018 China Health and Retirement Longitudinal Study (CHARLS), a representative database of adults aged > 45 years from China. We conducted logistic regression analyses to assess the likelihood of having discordant (conditions from different disease systems) versus concordant (only cardiometabolic, or only respiratory diseases) multimorbidity, and to compare the health status and healthcare utilization between patients with discordant and concordant multimorbidity. Latent class analysis (LCA) was applied to both the entire sample and to patients with discordant multimorbidity to identify clusters of disease combinations. Results The sample included 1668 patients with concordant (mainly cardiometabolic), and 7306 patients with discordant, multimorbidity. Female patients, patients living in rural settings, former and current smokers, and patients engaging in high-intensity physical activity, were more likely to have discordant instead of concordant multimorbidity. Depression, limitations in daily activities, poor self-reported health, and frequent healthcare use were more common in patients with discordant than concordant multimorbidity. The LCA identified five clusters when all multimorbid patients were included (cardiometabolic, arthritis-digestive, respiratory, multisystem, and arthritis-hypertension classes), and four clusters when restricted to discordant multimorbidity (digestive, arthritis-cardiometabolic, respiratory, and multisystem classes). Conclusion Discordant multimorbidity is associated with poorer health and increased use of healthcare. Cardiometabolic diseases, arthritis, and digestive diseases have a central role in defining disease patterns.

AIM:We investigated information needs and current knowledge on conflicts of interests (COIs) and funding in guidelines among guideline contributors. METHODS:We invited contributors, including methodologists, medical staff, journal editors, and health policymakers, from China, Japan, and South Korea to an online survey on the knowledge and information needs related to COI and funding in guidelines. The results were presented descriptively using frequencies and percentages. RESULTS:A total of 342 (94.2% of the 363 questionnaires that were initiated) were considered valid and included in the analysis: 188 were from China, 92 from Japan, and 62 from South Korea. Most respondents (n = 307, 89.8%) were aware of issues related to COIs and funding in guidelines. Of these 307 respondents, 44 (14.3%) had participated in guideline development without filling out a declaration of interest form, and 287 (93.5%) believed that it would be necessary to standardize the reporting of information on COIs and funding in guidelines. Most respondents found the division into financial and nonfinancial interests the most appropriate way to categorize COIs (n = 155, 50.5%) and agreed that all guideline contributors should disclose their interests (n = 245, 79.8%). Most respondents would agree to set thresholds for individual financial COIs (n = 240, 78.2%) and funding (n = 239, 77.8%), amounts below which would not need to be disclosed. CONCLUSION:Nearly 80% of the respondents supported mandatory disclosure of potential COI for all guideline contributors. The RIGHT-COI&F reporting guideline is an important step in the right direction, improving the transparency and comprehensiveness of guidelines.

Health economics evidence plays an important role in linking clinical value evidence with health resource allocation decisions in the development of clinical practice guidelines. It can not only effectively balance clinical effectiveness and economic feasibility but also avoid forming "idealized" recommendations that are detached from the affordability of the healthcare system or the burden-bearing capacity of patients. To promote guideline developers to use health economics evidence more standardizedly and fully, this paper conducts an in-depth analysis of the current application status, existing challenges, access channels, and application processes of health economics evidence in current guidelines, and on this basis, puts forward considerations and suggestions for strengthening and standardizing the application of health economics evidence in China's clinical practice guidelines.

Background: Chinese medicine (CM) and the integrated Chinese-Western medicine (ICWM) have been recognized and commonly used in the management of rheumatoid arthritis (RA). This study aimed to leverage the AI-empowered Clinical Evidence for Integrated Chinese-Western Medicine (ACE-iMed) platform to identify clinical evidence on CM and ICWM for RA, categorize and assess it by literature type, and provide evidence summaries. Methods: Following the ACE-iMed methodology, we first constructed a dedicated literature database for RA and identified clinical questions (CQs) and outcomes of interest to clinicians in the management of RA. Furthermore, for each specific CQ, we performed target searches and screening within the database, extracted data, assessed risk of bias/methodological quality, performed data analysis and provided evidence summaries. Results: Following literature searches and deduplication, 11,635 records were used to construct the RA and CM literature database. Across 18 questions covering ten major CM interventions and two comparisons, 556 records were ultimately identified, including 17 clinical practice guidelines/consensus statements, 35 systematic reviews, and 504 randomized controlled trials. Seven (38.9%) of the 18 CQs were supported by evidence from all three literature types. This study selected and presented evidence summaries for two CQs. Details and summaries of included studies for all CQs are available on the ACE-iMed platform. Conclusion: This study and relevant ACE-iMed platform provide a structured overview of clinical evidence on both CM and ICWM questions regarding RA, which can support clinicians in accessing evidence rapidly and identifying evidence distribution patterns and research gaps, and may inform future research and evidence-based practice.

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin disorder with substantial global burden. In some regions, Chinese medicine (CM) and integrated Chinese-Western medicine (ICWM) are widely used, but the overall clinical evidence remains unclear. This study aimed to systematically map and synthesize evidence on CM and ICWM for AD. Methods: A structured literature review was conducted using 14 predefined clinical questions to guide evidence mapping. CNKI, Wanfang Data, PubMed, Cochrane Database of Systematic Reviews, and CENTRAL were searched from inception to September 6, 2025. Included studies comprised clinical practice guidelines/consensus statements (CPGs/CSs), systematic reviews/meta-analyses (SR/MAs), and randomized controlled trials (RCTs) evaluating CM versus conventional Western therapy (CWT), or CM plus CWT versus CWT. Risk of bias and methodological quality were assessed using AGREE II, AMSTAR 2, and ROBUST-RCT tools. Results: A total of 285 studies were included (19 CPGs/CSs, 16 SR/MAs, 250 RCTs). Evidence was most abundant for oral Chinese herbal medicine (CHM) combined with CWT and for external CHM therapies. Integrated oral CHM plus CWT generally improved disease severity, pruritus, and quality of life compared with CWT alone. External CHM therapies showed comparable or superior efficacy to topical corticosteroids, with similar or fewer adverse events. Methodological quality was heterogeneous, and outcome reporting was often incomplete. Conclusion: The current evidence suggests potential benefits of CM and ICWM for AD, particularly for oral CHM combined with conventional therapy and external CHM interventions. However, the overall certainty of evidence is limited by methodological weaknesses and incomplete reporting.

ObjectiveTo introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.MethodsA systematic search was conducted in guideline development manuals and relevant methodological literature, covering publications up to October 25, 2024. Terminology related to the three aforementioned stages of related to guideline development was extracted from the included literature, standardized, and refined through consensus meetings to finalize a comprehensive terminology list and definitions.ResultsA total of 30 guideline development manuals and 15 methodological articles were included, and 23 core terms were identified.ConclusionsIt is recommended to develop a standardized and scientifically sound guideline terminology system with unified naming, clear definitions, and alignment with the linguistic environment and usage habits in China. At the same time, it is essential to strengthen terminology training for both guideline developers and users based on this system, in order to deepen their correct understanding and proper application of guideline terminology.

OBJECTIVES:The use of guidelines in multimorbidity-related practice has not yet been extensively investigated. We aimed to explore how health-care professionals use guidelines when managing individuals with multimorbidity. METHODS:We conducted an exploratory survey among a convenience sample of medical professionals with clinical experience. The questionnaire addressed whether and how different types of guidelines are used in multimorbidity-related practice, the reasons for not using specific types of guidelines, and other approaches to inform multimorbidity practice. It was distributed through the investigators' contact networks. The results were presented descriptively. RESULTS:We received 311 valid responses: 136 from the World Health Organization European Region, 137 from the Western Pacific Region, and 38 from other regions. Most participants were familiar with the concept of multimorbidity (n = 245, 79%). Among the 269 respondents who reported using guidelines in multimorbidity practice, 124 (46%) used guidelines specifically focusing on combinations of diseases, and 148 (55%) multiple single-disease guidelines together. Lack of availability was the main reason for not using guidelines that address multimorbidity itself, and the high number of guidelines (n = 76, 40%) and possible interactions between conditions or treatments (n = 62, 38%) for not using single-disease guidelines. Respondents frequently consult experts or refer to systematic reviews and primary studies when existing guidelines do not meet their needs. The development of a tool or method to guide the use of multiple guidelines ranked highest among possible actions to improve multimorbidity practice. CONCLUSION:Although the medical professionals in our sample were generally familiar with the use of guidelines, there are many unmet needs and tool gaps related to guideline-informed multimorbidity-related practice.

BACKGROUND:Mobile health plays a vital role in providing personalized treatment and management for patients with hypertension by enhancing physical activity interventions. However, there is a lack of comprehensive evidence on the efficacy of mobile health interventions in this context. This study aims to assess the impact of mobile health interventions on physical activity among adults with hypertension and evaluate the characteristics and effectiveness of different mobile health devices. METHODS:We conducted literature searches across multiple databases from inception to December 31, 2024, including PubMed, MEDLINE, EMBASE, The Cochrane Library, Google Scholar, China National Knowledge Internet, WanFang Data, Cqvip, and Sinomed. We specifically focused on randomized controlled trials assessing the impact of mobile health interventions on physical activity in adults with hypertension, irrespective of language. Our analysis included outcomes such as changes in systolic blood pressure, diastolic blood pressure, body mass index, and physical activity levels. We evaluated publication bias using funnel plots and Egger regression, assessed the risk of bias with the Cochrane risk-of-bias tool RoB2.0, and appraised the overall evidence quality using GRADE criteria. RESULTS:Our systematic review identified 69 eligible studies comprising 15,362 participants. The modalities used in mobile health interventions included wearable devices, cellphones, Short Message Service or Email, WeChat, smartphone applications or mini programs, internet platforms or a combination of technologies. Compared to the control group, participants receiving mobile health interventions showed greater decreases in systolic blood pressure by 7.17 mm Hg (95 % confidence interval: -8.42 to -5.92; p < 0.01) and diastolic blood pressure by 4.92 mm Hg (95 % confidence interval: -6.45 to -3.40; p < 0.01). Additionally, improvements were observed in body mass index with a reduction of 0.81 kg/m2 (95% confidence interval: -1.17 to -0.45; p < 0.01), physical activity scores (standard mean difference = 2.15 [95 % confidence interval: 1.27 to 3.02]; p < 0.01), and the number of physical activity adherents (relative risk = 1.61 [95 % confidence interval: 1.32 to 1.96]; p < 0.01). Other health outcomes including waist circumference, blood lipids (Total Cholesterol, Triglycerides, High-Density Lipoprotein, Low-Density Lipoprotein), fasting blood glucose, and minutes of physical activity also showed improvements. A higher baseline systolic blood pressure and diastolic blood pressure were associated with more pronounced reductions, ranging from -10.83 to -5.15 mm Hg for systolic blood pressure and from -11.78 to -1.72 mm Hg for diastolic blood pressure. CONCLUSIONS:Physical activity interventions in adults with hypertension using mobile health technologies are beneficial for managing hypertension, improving health indicators, and increasing physical activity levels effectively. It is recommended that future research investigate the ideal intervention duration, patient preferences, and the cost-effectiveness of these technologies. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42023432347.

Background:Long COVID, a persistent condition following SARS-CoV-2 infection, exhibits diverse symptoms across multiple organ systems. This study aims to summarize the existing clustering and classification approaches to support the management of Long COVID. Methods:Following PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and Google Scholar from their inception to January 21, 2025, and updated the search on October 1, 2025, to identify studies that presented a way to categorize Long COVID patients or symptoms. Data extraction and quality assessment were conducted for eligible studies. We presented symptom co-occurrence networks, and performed meta-analysis to estimate the percentage of different organ system-based symptom clusters. In addition, we conducted an exploratory analysis of the determinants of different symptom clusters. The protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/J483F). Findings:Forty-seven cohort studies and 17 cross-sectional studies categorizing Long COVID subtypes or symptoms were included, encompassing 2.43 million participants across 20 countries. The methodological quality of the cohort studies was on average high (mean Newcastle-Ottawa scale score: 7.5/9), and of the 17 cross-sectional studies moderate (mean Joanna Briggs Institute tool score: 0.61/1.00). Patients or symptoms were categorized either according to the co-occurrence of symptoms (n = 30 studies, 46.9%); by the affected organ system (n = 16, 25.0%); by severity stratification (n = 9, 14.1%); by clinical indicators (n = 3, 4.7%); or by using other ways of classification (n = 6, 9.4%). Among the 30 studies defining patient clusters by the co-occurrence of symptoms, fatigue was the most frequently used descriptor for a cluster, either alone or together with other symptoms (n = 15 studies). Pairwise co-occurrence analysis revealed some commonly used symptom dyads, including olfactory-gustatory dysfunction (n = 10 times), anxiety-depression (n = 10) and joint pain/swelling-muscle pain (n = 9). Fatigue was a recurrent core symptom, frequently co-occurring with joint pain/swelling (n = 9 times) or muscle pain (n = 7), cognitive symptoms (n = 7), and dyspnea (n = 7). Meta-analysis of the organ system-based subtypes showed that respiratory symptom cluster had the highest pooled percentage (47% [95% CI: 29%-65%]), followed by neurological (31% [95% CI: 3%-60%]) and gastrointestinal clusters (28% [95% CI: 0%-57%]). These percentages represent the proportion of Long COVID patients with each symptom cluster within the 16 included organ system-based subtyping studies, not population-level prevalence of Long COVID. Exploratory analysis indicated that symptom subtypes were influenced by factors such as sex, age, virus variant, and comorbidities. Interpretation:This review identified four major approaches for categorizing Long COVID patients and their symptoms. Symptom co-occurrence and organ system were the most commonly used subtypes used in categorization. Fatigue and olfactory-gustatory dysfunction emerged as recurrent core symptoms across multiple subtypes of Long COVID. Funding:This work was supported by the K. C. Wong Education Foundation, Hong Kong, the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2024-I2M-ZD-011), the Beijing Nova Program (20240484523), the Elite Medical Professionals Project of China-Japan Friendship Hospital (NO. ZRJY2024-GG03), and the National High Level Hospital Clinical Research Funding.

ObjectiveTo sort, summarize, and introduce key terms related to guideline reporting, evaluation, dissemination, implementation, and updating.MethodsWe systematically searched guideline development manuals and methodological literature from database inception to October 25, 2024. Terms related to guideline reporting, updating, evaluation, and implementation were extracted, standardized, and finalized through a structured consensus process.ResultsA total of 13 guideline manuals and 32 methodological articles were included, yielding 14 core terms with standardized definitions.ConclusionsThis article introduces key terms such as reporting standards, external review, and research gaps across guideline development phases to promote concept application and deepen readers' understanding of guideline development.

Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries (LMICs), though their effectiveness in multimorbidity management remains unclear. This study synthesised evidence on task-shifting and task-sharing strategies globally and assessed the impact on core health outcomes in multimorbidity management.Methods We conducted a systematic review and meta-analysis of global studies evaluating task-shifting and sharing interventions for individuals with multimorbidity. Six databases, including PubMed, Embase, Web of Science, Ovid (Medline), CINAHL and Cochrane Library, were searched for studies reporting the core outcomes of multimorbidity management in quality of life, mortality, hospitalisation, emergency department visits and symptoms of depression and anxiety. Random-effects models were used to calculate pooled effect sizes with heterogeneity assessed through subgroup and meta-regression analyses.Results From 8471 records, 36 studies from 14 countries were included, with only 5 conducted in LMICs. Twenty-one studies, encompassing 20 989 participants, were eligible for meta-analysis. More than half of the studies involved nurses as delegates, with some sharing the tasks with health professionals and about 10% of studies involved non-health professionals, including community healthcare workers as delegates to share the responsibility in caring for individuals with multimorbidity. Most studies were multicomponent, with 16.7% addressing all guideline-recommended aspects of multimorbidity management. By pooling the findings, task-shifting and task-sharing interventions were associated with a 27% reduction in mortality (OR: 0.73, 95% CI: 0.55 to 0.97, I²=0%), a modest improvement in quality of life (standardised mean difference (SMD): 0.1, 95% CI: 0.03 to 0.17, I²=47%) and reduced symptoms of depression (SMD: 0.27, 95% CI: −0.52 to –0.02, I²=90%), but showed no significant effect on hospitalisation, emergency visits or anxiety-related symptoms.Conclusions Some evidence, although limited in existing research, indicates the great potential of task-shifting and task-sharing strategies in supporting management of multimorbidity. Further research is needed to optimise and adopt these interventions, particularly in LMICs where evidence remains scarce.PROSPERO registration number CRD42024526845.

Policies on conflicts of interest (COI) and funding are essential to reduce the risk of bias in the guideline development process. To collate and review the content related to COI and funding policies from guideline development handbooks. We searched PubMed from its inception until September 10, 2021, websites of key guideline development organizations and Google for guideline development manuals that included COI or funding policies, and performed a cross-sectional review. Fifty-seven guideline development manuals were included. Amongst the 54 handbooks containing a COI policy, all required disclosure of interests. Nineteen (35.2%) manuals defined what constitutes a COI, and 52 (96.3%) specified who should disclose their interests. Thirty-four (63.0%) manuals recommended an assessment of disclosed interests to determine whether a COI existed, and all of these specified who should perform this review. Thirty-five (64.8%) manuals addressed the management of COI, of which 26 (74.3%) indicated who should manage COI and 29 (82.9%) reported specific management measures. Twenty-eight (51.8%) manuals addressed the publication of COI, all recommending that these be publicly accessible. Of the 28 manuals that provided guidance on funding, eight (28.6%) required reporting of funding sources; 14 (50.0%) required that the guideline authors state that the funders' perspectives and interests did not affect the final recommendations; eight (28.6%) specified which kind of funding the guidelines should not accept; and five (17.9%) recommended that the role of funders be restricted. Policies in guideline manuals report a variety of different elements related to COI and funding. However, a considerable part of the policies did not report precisely what constitutes a COI, the key steps for COI management, or address the sources, influence and acceptability of funding.

BackgroundThe burden of multimorbidity is increasing globally, which complicates the use of guidelines in clinical practice and health care: practitioners may need to increasingly refer to multiple guidelines with potentially conflicting recommendations. ObjectiveWe aim to develop a guideline-based decision support framework for the management of patients with multimorbidity to help clinicians efficiently evaluate, select, and adapt recommendations focusing on the different comorbidities and aspects of multimorbidity. MethodsWe will conduct the project using the following steps: (1) needs assessment (searching published literature and documents on guideline use in multimorbidity care through the study initiators, and assessing the necessity of developing a comprehensive decision-making framework focusing on multimorbidity in a broad sense), (2) establishing international working groups (a coordination team, an evidence support group, and a consensus group) by leveraging existing participants’ networks and inviting experts with relevant academic publications or activities, (3) conducting literature reviews of multimorbidity guidelines and original qualitative research involving interest-holders in multimorbidity care and/or guideline development to formulate an initial draft framework, (4) a consensus process including an expert survey and a consensus meeting, (5) formulating and releasing the final framework, and (6) testing the framework (collecting feedback through educating health professionals in different settings and applying the framework in practice to evaluate and improve it). We plan to complete the project within 3 years. ResultsThe project has started in March 2024 and is due to conclude in June 2026. As of May 2025, we have finished the literature reviews and qualitative studies and are currently conducting the first round of the expert survey. ConclusionsThis framework will help clinicians from all levels of health care institutions to make decisions in the management of patients with multimorbidity based on the latest available evidence, and to reduce potential health risks to their patients. One limitation of this framework is that such a broad framework may not fully fit all disease combinations or realistic situations. To reduce the degree of inapplicability, after completion of the framework, we will continue to monitor its use with regular updates as needed. International Registered Report Identifier (IRRID)DERR1-10.2196/63339

Objectives This study aimed to systematically map the development methods, scope, and limitations of existing artificial intelligence (AI) reporting guidelines in medicine and to explore their applicability to generative AI (GAI) tools, such as large language models (LLMs). Study Design and Setting We reported a scoping review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Five information sources were searched, including MEDLINE (via PubMed), Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, China National Knowledge Infrastructure, FAIRsharing, and Google Scholar, from inception to December 31, 2024. Two reviewers independently screened records and extracted data using a predefined Excel template. Data included guideline characteristics (eg, development methods, target audience, AI domain), adherence to EQUATOR Network recommendations, and consensus methodologies. Discrepancies were resolved by a third reviewer. Results Sixty-eight AI reporting guidelines were included; 48.5% focused on general AI, whereas only 7.4% addressed GAI/LLMs. Methodological rigor was limited; 39.7% described development processes, 42.6% involved multidisciplinary experts, and 33.8% followed EQUATOR recommendations. Significant overlap existed, particularly in medical imaging (20.6% of guidelines). GAI-specific guidelines (14.7%) lacked comprehensive coverage and methodological transparency. Conclusion Existing AI reporting guidelines in medicine have suboptimal methodological rigor, redundancy, and insufficient coverage of GAI applications. Future and updated guidelines should prioritize standardized development processes, multidisciplinary collaboration, and expanded focus on emerging AI technologies like LLMs.

OBJECTIVES:Recently, we published a reporting checklist for conflicts of interest (COI) and funding in practice guidelines and guideline organizations' policy documents, RIGHT for Conflicts of Interest and Funding (RIGHT-COI&F). In this study, we examined the reliability and usability of this new tool in practice to assess reporting. STUDY DESIGN AND SETTING:We extracted a sample of guideline development organizations' COI and funding policies, and all guidelines developed by the World Health Organization (WHO) since 2019. We evaluated the adherence of these documents to the applicable items of RIGHT-COI&F. External reliability was assessed with the Kappa coefficient. We also surveyed key interest-holders on the ease of understanding of the tool who were asked to score each item on a scale from 1 (very difficult to understand) to 7 (very easy to understand). RESULTS:We evaluated the COI and funding policies of 28 guideline development organizations and 62 WHO guidelines. The mean Kappa value between the evaluators was 0.90 (full range 0.82-0.95), demonstrating good external reliability. Guideline policies adhered on average to half of the applicable items. The majority (77%) of WHO guidelines adhered to most applicable items. The mean times to evaluate policies and guidelines using the applicable items of the RIGHT-COI&F checklist were 28 and 30 minutes, respectively. The survey was completed by 157 individuals. The mean scores for ease of understanding were greater than five for all items. CONCLUSION:RIGHT-COI&F checklist demonstrated good reliability and usability when used to assess reporting of COI and funding in practice guidelines and guideline organizations' policy documents.

To improve the standard screening, diagnosis, and treatment of hypertension in patients in China; realize the standardization of clinical practice of hypertension; and improve the prevention and control level of hypertension in China, it is both important and necessary to develop a clinical practice guideline for hypertension according to a recognized methodology. Jointly sponsored by the National Center for Cardiovascular Diseases, Chinese Medical Doctor Association, Hypertension Committee of the Chinese Medical Doctor Association, Chinese Society of Cardiology, and Hypertension Committee of Cross-Straits Medicine Exchange Association, the “Chinese Clinical Practice Guidelines of Hypertension” was proposed. Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, Guideline and Standards Research Centre of Chinese Medical Association Publishing House, Lanzhou University Institute of Health Data Science, and Lanzhou University GRADE Center will provide methodological support for the guidelines.

OBJECTIVES:Patient and public versions of guidelines (PVGs) have gradually gained wide recognition and attention from the public and the society due to their scientific, professional, and authoritative characteristics. This study aims to survey the awareness and knowledge of PVGs among stakeholders in China. STUDY DESIGN AND SETTING:This was a cross-sectional survey among stakeholders (guideline developers, clinicians, journal editors, patients, and the public) in China. We self-designed the questionnaire and distributed it through the Questionnaire Star platform. The primary outcomes were awareness of PVGs and opinions about the development methodology, writing, dissemination, and implementation of PVGs. The Kruskal-Wallis H test and post hoc multiple comparison tests were used to compare the levels of awareness of PVGs between different subgroups of respondents. RESULTS:A total of 1319 valid questionnaires were collected: 722 from guideline developers, 136 from clinicians, 83 from journal editors, 284 from patients, and 94 from members of the public. Of all respondents, 253 (19.2%) had not heard of PVGs, 349 (26.5%) had heard of PVGs but had no further knowledge, 475 (36.0%) had some knowledge of PVGs, and 242 (18.3%) were familiar with or had participated in the development of PVGs. Guideline developers, clinicians, and journal editors had higher awareness than patients and the public. Higher education and older age also correlated with higher awareness of PVGs. More than half (52.9%) of guideline developers considered that both rewriting of the source guidelines and direct development as independent documents were appropriate methods for developing PVGs. The survey respondents agreed that clinicians (97.3%), guideline methodologists (76.6%), representatives of patients and the public (74.5%), and medical editors or writers (63.4%) should participate in the development of PVGs. More than 80% of the respondents agreed that the quality of evidence and strength of recommendations should be presented; however, there was no consensus in the form of presentation. CONCLUSIONS:The level of awareness of PVGs among stakeholders in China is relatively low and differs between different stakeholder groups, but the majority of key stakeholders have a positive attitude toward PVGs. The collection of the perspectives and opinions on the development methods, writing, dissemination, and implementation provides a key reference and basis for the future optimization and improvement of PVGs development.