key: cord-319016-ymypvg6k authors: Li, Yu-xi; Li, Juan; Zhang, Yue; Tian, Yan-ping; Zhang, Yong-gang; Jin, Rong-jiang; Guo, Yan; Clarke, Mike title: Clinical Practice Guidelines and Experts’ Consensuses for Treatment of Coronavirus Disease 2019 (COVID-19) Patients with Chinese Herbal Medicine: A Systematic Review date: 2020-10-08 journal: Chin J Integr Med DOI: 10.1007/s11655-020-3431-x sha: doc_id: 319016 cord_uid: ymypvg6k nan diarrhea, which also relates to dampness. Therefore, in CM, the combination of the outbreak location and clinical manifestations of COVID-19 patients, shows that the onset of COVID-19 is mostly caused by pathogen of dampness. (6) This leads to the suggestion that herbs with functions of promoting Fei (Lung) and expelling dampness can be applied, and the use of CM has been associated with benefi ts against COVID-19. (7, 8) This study provides a summary and appraisal of these guidelines, using systematic review methods. We This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidance. (11) The study protocol was registered in the International P r o s p e c t i v e R e g i s t e r o f S y s t e m a t i c R e v i e w s (No. CRD42020179205) and has been published. (12) The full PRISMA checklist and fl ow diagram are in Appendix 1. Clinical practice guidelines, expert consensus statements and guidance documents which provided information on using CHM for COVID-19 patients were included. To be eligible, the guidelines should be Two reviewers (LYX and ZDL) independently identified potentially eligible guidelines according to predetermined criteria. Disagreements were discussed and arbitrated by a third reviewer (ZYG). In order to achieve consistency in extracted items, the data extraction process was piloted using a sample of eligible The methodological quality and reporting quality of the included guidelines were evaluated using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) Ⅱ tool (14) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement, (15) respectively (see below). To ensure at least 80% consistency in quality assessments, we pre-assessed a sample of eligible guidelines and discussed the results among reviewers. The kappa coeffi cient was also evaluated. Subsequently, 2 reviewers (LYX and LJ) independently appraised the quality of each included guideline. Discrepancies were discussed and resolved among the reviewers. The AGREE Ⅱ instrument is a tool that can be used to assess the methodological rigour and transparency in the development of a guideline. (13, 16) It consists of 23 items in 6 domains: (1) scope and purpose (items 1-3), Microsoft Excel 2019 was used to summarize and analyze the recommendations for treating COVID-19 patients with CM formulae and CPM, as well as the results of quality assessment. A total of 275 records in electronic databases and 26 records on websites of governments and organizations were identifi ed. After careful assessment, 45 of these met the inclusion criteria and were included for analysis (Appendix 2). (10, As noted above, in CM theory, the main pathogens The kappa values for our independent assessments of the included guidelines using the AGREE Ⅱ checklist and RIGHT checklist ranged from 0.73 to 0.82, indicating good consistency for quality assessments. Using AGREE Ⅱ, we rated only one of the 45 included guidelines as moderate quality (achieving 63%). The others were all of low quality, with scores from 18% to 44%. The score of each domain of AGREE Ⅱ and the overall quality of each included guideline are summarized in Appendix 5. Domain 4 (Clarity of presentation) achieved the highest mean score at 72% (range 28% to 83%), However, it is still clear that some guidelines, such as those published by expert groups or associations, need to improve their methodological and reporting quality to allow them to meet the standards of AGREE Ⅱ and RIGHT. To achieve a solid evidence, future research should follow the AGREE Ⅱ and RIGHT checklist during the guideline development. (70) Recently, Ang, et al (71, 72) published two rapid reviews of guidelines of herbal medicine for COVID-19. We have improved on those by systematically searching and retrieving more guidelines relating to the recommendation of CHM for COVID-19 patients based on CM theory. We also conducted this systematic review with prior study design and registration, and independently evaluated each included guideline against recognized standards for practice guidelines: AGREE Ⅱ for methodological quality and RIGHT for reporting quality. These fi ndings provide useful insights for future guideline developers and people studying guidelines and guideline development. This study has some limitations: (1) we only searched Chinese and English databases, so our findings may not apply to guidelines in other languages; (2) we summarized formulae and CPMs if they were originated from Chinese classic medical books with prescription names and if they were recommended in more than 2 guidelines, which means that there may be some missing information, such as prescriptions based on local doctors' experiences or recommendations in a single guideline; (3) the methodological and reporting quality of most of included guidelines was low, which may infl uence the certainty of our results. In conclusion, this study has summarized current recommendations for the use of CHM to prevent COVID-19 and to treat it during the medical observation period and clinical treatment period; including in the early, development, critical and recovery stages. However, the general quality of present guidelines is low and the development of future guidelines should include increased awareness of the features of good quality guidelines. 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