The speaking valve, a one-way device that restores physiological airflow, provides significant benefits for tracheostomy patients by enhancing phonation, swallowing, airway clearance, and psychological health. It also supports weaning from mechanical ventilation and promotes decannulation. However, inconsistent application in China poses potential risks. To address this, Chinese Association of Medical Rescue, Critical Care Branch, Chinese Medical Education Association, Critical Care Rehabilitation Branch jointly developed an expert consensus on the clinical application of speaking valves. This consensus includes 19 recommendations covering patient eligibility, device selection, operational protocols, adverse event management, and multidisciplinary team training. By emphasizing standardized assessment, timely monitoring, and collaborative practice, it seeks to ensure the safe and effective use of speaking valves in tracheostomy patient rehabilitation.
The global initiative for chronic obstructive lung disease (GOLD) 2025 report, released on November 11th, 2024, marks the second update since GOLD 2023. Overall, this version maintains similar definition, diagnosis, assessment, and treatment for COPD as in GOLD 2024, but with revisions and expansions in 12 specific areas. These include: added explanations and references on lung function trajectories, expanded content on dysbiosis, updates and additions to spirometry, revised cardiovascular risk information for COPD patients, updated guidance on CT imaging for COPD, new insights into the impact of climate change on COPD, updated vaccination recommendations, updated follow-up pharmacological treatments, new guidance for delivery of pulmonary rehabilitation, revised recommendations on ICS withdrawal in patients on LABA+ICS therapy, updated information on PDE3 and PDE4 inhibitors and other exacerbation-reducing medications, and additional content on pulmonary hypertension. The article introduces and interprets the new contents.
When insomnia and obstructive sleep apnea (OSA) coexist, it is referred to as comorbid insomnia and obstructive sleep apnea (COMISA). The prevalence of COMISA in the general population ranges from 0.6% to 19.3%. It is primarily characterized by difficulty falling asleep, frequent nighttime awakenings, early morning awakening, poor sleep quality, snoring or apnea during sleep, unrefreshing or nonrestorative sleep, excessive daytime sleepiness, fatigue, attention impairment, memory impairment, emotional disorders, and impaired quality of life. COMISA can lead to adverse outcomes in multiple systems and increase all-cause mortality. Therefore, it is significant to establish a guidline for the diagnosis, differential diagnosis, and standardized treatment of COMISA. The guideline was organized by the Chinese Academy Society of Sleep Medicine, Chinese Medical Doctor Association and Sleep Medicine Group, China Neurologist Association. It was formed by reviewing domestic and international COMISA diagnosis and treatment practices, through literature evidence review, and after extensive discussion. The guideline summarized the epidemiology, etiology and risk factors, pathophysiological mechanisms, clinical manifestations, assessment methods, diagnosis, differential diagnosis, and treatment studies of COMISA, providing a basis for decision-making in the diagnosis and treatment of COMISA for clinician.
The incidence of acute poisoning caused by commonly used clinical drugs has been increasing annually, yet specific antidotes are lacking for most drug poisonings. Blood purification plays a crucial role in the treatment of acute poisoning. However, there are currently no unified recommendations in China regarding its application in cases of acute poisoning from commonly used clinical drugs. This consensus centers on pharmacokinetics, summarizing and outlining the strategies for applying blood purification in the treatment of acute poisoning caused by these drugs. Its aim is to assist clinicians in improving their understanding of pharmacokinetic parameters and the corresponding blood purification methods, so that they can select the appropriate blood purification technique and develop suitable treatment plans based on the pharmacokinetic characteristics of the drug involved. Ultimately, this seeks to improve outcomes in treating patients with acute poisoning from commonly used clinical drugs.
To enhance the overall health management for patients with gynecologic malignant tumors, and to fully leverage the role of primary healthcare institutions in screening and rehabilitation, the Gynecological Oncology Group of the Oncology Department of Capital Medical University, in collaboration with experts in general medicine, nutrition, psychology, rehabilitation medicine, nursing, and health statistics, has formulated the Expert Consensus on Management of Common Gynecological Malignancies Combining General Practice and Specialist. This consensus, based on evidence from evidence-based medicine, the current status of primary medical institutions, and relevant guidelines for the management of gynecological malignancies, emphasizes the early identification of gynecological malignancies and proactive intervention in related health issues. Community management of patients with common gynecological malignancies should be centered around gynecologists or general practitioners, in collaboration with a multidisciplinary oncology rehabilitation team. The management covers aspects such as prevention, screening, follow-up and referral, psychological counseling, exercise rehabilitation, nutrition management, continuity of care, systematic health education, and social function recovery, aiming to prolong survival and enhance the quality of life for patients.
Behavior and lifestyle interventions (BLIs) can reduce blood glucose and blood pressure, regulate blood lipids, control obesity, reduce cardiovas cular events and are a first-line treatment for chronic diseases such as diabetes mellitus. BLIs include helping patients maintain a healthy diet, adhere to physical exercise, maintain a normal weight, ensure good sleep, avoid smoking and alcohol abuse, make good psychological adjustments, establish good social support, as well as scientific self-monitoring of blood glucose and adherence to drug therapy. Except for the severe hyperglycemia and acute complications requiring medication, patients with newly diagnosed diabetes mellitus should first undergo BLIs. BLIs should follow the principles of effectiveness-centered, mutual trust establishment, problem-solving orientation, integration, and individulization. Common strategies for BLIs include applying behavior change theories, utilizing behavior change technologies, effectively emlpoying communication strategies, improving patient behavior skills, and implementing patient-centered self-management education and support (DSMES). The steps of BLIs include evaluating behavior, lifestyle and their influencing factors, setting behavioral goals, developing intervention plans, and conducting interventions and effectiveness evaluation. The evaluation measures for the effectiveness of BLIs include process indicators, clinical outcomes, socio-psychological and behavioral outcomes, patient reports, and health outcomes. Evaluation can be performed using a combination of qualitative and quantitative methods. Common evaluation tools include the SDSCA, PAM, and DMSES.
The rapid development of new technologies such as artificial intelligence and large language models has brought new transformations to clinical medical practice. Both domestically and internationally, research and practical exploration of intelligent general practitioners have begun, but a consensus has yet to be formed. Against this backdrop, experts and scholars from Tsinghua University Vanke School of Public Health, Peking University School of Public Health, Chinese Association of General Practitioners of Chinese Medical Doctor Association and several other domestic institutions collaboratively developed a consensus. The background of these experts spans multiple disciplines, including general medicine, public health, artificial intelligence, and evidence-based medicine. Based on extensive literature review both domestically and internationally and through multiple rounds of expert discussions, the Chinese Expert Consensus on Artificial Intelligent General Practitioner (AIGP) was finally formulated. It includes 17 core consensus concerning the definition, characteristics, applications, challenges and recommendations of AIGP. This consensus aims to provide scientific references to promote the empowerment of general practitioners with intelligent technology and enhance the smart service level of primary healthcare.
Test anxiety disorder is a group of symptoms related to stress caused by tests, exams, evaluations, and others. It is among the severe psychological problems in exams. Long-term test anxiety is likely to cause tension, fear, irritability, depression, and other negative emotions, and it disturbs working memory, attention, and other cognitive abilities and even leads to suicidal ideation. In order to standardize the clinical diagnosis and treatment of test anxiety disorder, under the organization of the Test Anxiety Disorder Collaboration of the Chinese Society of Psychosomatic Medicine, this expert consensus was formulated by 13 experts in the field of psychiatry and psychology. We collaborate and announce the expert consensus based on current research and clinical experience. We hope the consensus can provide clinicians with scientific and comprehensive guidance on test anxiety disorder, including epidemiology, etiology, clinical manifestations, evaluation, and treatment.
Diabetic microvascular disease (DMiVD) is the most common chronic complication of diabetes mellitus, and early identification and effective intervention can significantly improve patients' quality of life and prognosis. The Diabetes and Microcirculation Professional Committee of Chinese Society of Microcirculation and the Primary Endocrine and Metabolic Diseases Group of the Chinese Society of Endocrinology have convened experts in the field to revise the Expert Consensus on Screening and Prevention of Diabetic Microvascular Diseases for Primary Care (2024), based on the 2021 edition, considering the latest research advances and the specific needs of primary care. This consensus elaborates the screening methods, comprehensive management and prevention strategies for DMiVD (diabetic retinopathy, diabetic kidney disease, distal symmetric polyneuropathy and diabetic cardiomyopathy), clarifies the graded diagnosis and treatment and referral processes, emphasizes the importance of preventing and treating DMiVD, and offers guidance and recommendations for physicians, particularly primary care physicians and general practitioners. The aim is to reduce the incidence, progression, and disability associated with DMiVD, ultimately lowering morbidity and mortality rates.
Obstructive sleep apnea (OSA) is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases, and affects cognitive function and multi-system organ function in the elderly. Therefore, it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society, as the initiator, organized domestic experts in related fields to repeatedly discuss the operation process, requirements, specific ways and methods of noninvasive positive pressure ventilation (NPPV) treatment for elderly OSA patients with reference to domestic and international clinical studies, and finally made this expert consensus, which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.
Clinical practice guidelines can standardize medical behaviors, improve the quality of medical services, rationalize resource allocation, and safeguard the rights of patients. However, all of these are achieved based on the rigorous design, scientific formulation, and standardized reporting of guidelines. With the nation's high attention to the standardization of traditional Chinese medicine, many clinical practice guidelines for traditional Chinese medicine or integrated traditional Chinese and Western medicine have been published. Traditional Chinese medicine orthopedics, as a discipline with obvious advantages in specialization in the field of traditional Chinese medicine, is witnessing a rapid increase in the number of clinical practice guidelines, prompting the discipline to gradually move towards standardization, modernization, and internationalization. However, many issues are increasingly emerging in this context, attracting widespread attention from researchers. This article systematically reviews and summarizes the current status and challenges of the development of clinical practice guidelines in orthopedics of traditional Chinese medicine, and proposes targeted strategies. Currently, the development of clinical practice guidelines in orthopedics of traditional Chinese medicine faces many challenges, including inaccurate positioning of clinical problems, a lack of high-quality clinical evidence, insufficient standardization in guideline formulation, a shortage of multidisciplinary talent development, and various issues regarding guideline updating and implementation. In future research, professional societies/associations should strengthen guidance on guideline formulation. Researchers should focus on improving the quality of original research, enhance learning and research in guideline methodology, prioritize guideline updating and adaptation, and promote the dissemination and implementation of guidelines, aiming to develop high-quality guidelines and promote the standardization of orthopedics of traditional Chinese medicine.
Lumbar disc herniation is one of the most common causes of low back pain, and the number of cases has been increasing year by year in recent years. High-quality guidelines can standardize clinical diagnosis and treatment behaviors and improve medical quality, and screening and formulating high-quality guidelines are of great significance for standardizing the clinical practice of lumbar intervertebral disc herniation.
To systematically evaluate the methodological quality of clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation, and to analyze the high-quality guidelines and consensus recommendations, in order to provide reference for the prevention and treatment of lumbar intervertebral disc herniation.
Clinical practice guidelines and expert consensus on lumbar intervertebral disc herniation were searched from the establishment of each database to October 31, 2023. At the same time, Dangdang.com and others were manually searched to obtain the guidelines for lumbar intervertebral disc herniation published in the form of monographs. After the consistency evaluation was passed by two researchers, the methodological quality of the included guidelines and consensus was evaluated using the AGREE Ⅱ tool, and the high-quality guidelines and consensus recommendations were analyzed.
A total of 15 guidelines and consensus were included, and the final recommendation level of 9 guidelines was B (can be recommended after modification), and 6 guidelines and consensus were C (not recommended for the time being). Recommendations mainly include bed rest, medication, surgical treatment, etc.
The methodological quality of the clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation needs to be further improved, and some treatment methods are controversial, and the recommendations of the guidelines need to be further improved and unified to optimize clinical practice.
Hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia are collectively referred to as the "three highs", which often coexist in the same individual. It significantly increases the risk of hospitalization, death, and relevant burdens for affected people. It is necessary to jointly control the risk and standardize the treatment of hypertension, T2DM and dyslipidemia. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention, treatment, and management of the "three highs", although norms, consensus, and guidelines for the co-management of the "three highs" in primary healthcare institutions at domestic and foreign are current not available. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from medical fields of cardiovascular diseases, endocrine, pharmacy, and public health services to participate in the consensus. Through widely soliciting clinical practice needs of primary healthcare workers, integrating and evaluating the evidence related to the prevention and treatment of the "three highs" in primary healthcare institutions, the consensus for primary healthcare in the prevention and treatment of the "three highs" including 21 opinions was developed after multiple rounds of discussions, revisions, and voting. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the "three highs", provide scientific strategic support, implement management with primary healthcare characteristics, and lay a solid foundation for comorbidity co-management.
Lumbar spinal stenosis is one of the most common causes of low back and leg pain. However, there is a lack of evidence-based guidelines for the treatment of lumbar spinal stenosis with integrated traditional Chinese medicine and western medicine. To standardize the diagnosis and treatment of lumbar spinal stenosis with a combination of traditional Chinese medicine and western medicine, this guideline strictly followed the relevant guiding principles for the development of guidelines both domestically and internationally. A multidisciplinary working group was established. We adopted the GRADE approach to grade the quality of evidence and the strength of recommendation. Finally recommendations on the treatment of lumbar spinal stenosis with integrated traditional Chinese medicine and western medicine were formed, aiming to standardize clinical practice. This guideline is for patients with all degrees of lumbar spinal stenosis.
Binge-eating disorder (BED) is a type of eating disorder characterized by recurrent episodes of binge eating. Patients with BED have recurrent impulsive and out-of-controlled binge eating behavior, which can lead to gastrointestinal disorders, obesity, and the resulting metabolic and functional disorders of various systems and other physical problems; and it is also often co-morbid with affective disorder, anxiety disorders, substance use disorders, and other mental disorders, which need to be taken seriously. However, the recognition of BED in China was late, and it is difficult to achieve early identification and diagnosis, resulting in a prolonged course of disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, an expert group composed of 15 psychiatrists and evidence-based medicine experts, and 2 internal medicine experts, formulated this expert consensus based on evidence-based medical evidence, domestic and foreign guidelines and expert consensus, and expert experiences. The aim of this study is to improve the recognition, diagnosis and treatment of BED by psychiatrists, internists and general practitioners in China.
Low-density lipoprotein cholesterol (LDL-C) is a pathogenic risk factor for atherosclerotic cardiovascular disease (ASCVD). In recent decades, the prevalence of dyslipidemia in the Chinese population increases continuously, it is urgent to improve blood lipid management in China. It is particularly important to carry out standardized blood lipid management at primary healthcare institutions. The Chinese Guideline for Lipid Management (Primary Care Version 2024) concisely recommends that LDL-C should be the preferred intervention target in lipid management, and the target values of LDL-C should be determined based on ASCVD risk stratification. The present guideline recommends to use moderate-intensity statins at the beginning of treatment on the basis of lifestyle intervention. If the LDL-C target level can not be reached, other lipid-lowering drugs like cholesterol absorption inhibitors or (and) proprotein convertase subtilisin/kexin type 9 inhibitors should be jointly used for the purpose of reaching the target value. The present guideline also provides blood lipid management strategies for special populations. We aim to provide guidance for primary healthcare professionals to carry out blood lipid management, and comprehensively improve their ability on blood lipid management, and thereby improve the primary and secondary prevention of ASCVD in China.
Post-COVID-19 condition is defined as the presence of symptoms that cannot be explained by other diagnoses, lasting for at least 2 months, occurring three months after a possible or confirmed SARS-CoV-2 infection. It is the result of a complex interplay of biological, psychological, and sociocultural factors, characterized by a high number of affected individuals, complex pathogenesis, diverse symptoms, and a significant need for long-term care. The diagnosis is considered exclusionary and can be classified into six subtypes, including non-severe COVID-19 multiorgan sequelae, pulmonary fibrosis sequelae, myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, post-intensive care syndrome, and medical or clinical sequelae. Based on comprehensive evaluation, treatment and care can be provided through a multidisciplinary approach involving medication, diet, exercise, psychological interventions, patient education, and other methods.
