Recurrent urinary tract infections (rUTI) are a common condition among female patients. It affects patients' quality of life, incurs the medical burden, and is associated with global antibiotic resistance. Currently, European and American countries have established clinical guidelines of rUTI to address the clinical issues. However, there is still a lack of consensus in the management of rUTI in China.
To summarize the existing evidence and guideline recommendations for the diagnosis, treatment, prevention of rUTI that can be used in China.
We conducted a systematic search in Chinese and English databases such as CNKI, VIP, Wanfang Data, PubMed, and Web of Science, as well as the associated official websites of urology, nephrology, and obstetrics and gynecology societies. We included guidelines related to female rUTI and the main randomized controlled trials and observational studies mentioned in these guidelines from November 2014 to November 2024.
A total of 274 articles were included in the review, encompassing 98 systematic reviews and meta-analyses, 129 randomized controlled trials, 15 observational studies, and 32 expert opinions/guidelines. In symptom management, guidelines generally recommend routine urine culture during acute exacerbations. For acute-phase antibiotic therapy, most guidelines recommended fosfomycin and nitrofurantoin, etc. Prevention strategies such as estrogen replacement, continuous low-dose antibiotic prophylaxis, immunoactive prophylaxis, and methenamine hippurate were with relatively strong evidence.
Most current guidelines mainly focused on the female population with uncomplicated cystitis. Clinical guidelines from different countries demonstrate consistency in antibiotic protocols for acute infection management, yet exhibit divergence in their recommendations for infection prevention strategies. Future guidelines should consider a broader scope, especially for rUTI populations with complicative factors such as diabetes and kidney diseases, to optimize the assessment and management of rUTI.
With global population ageing, sarcopenic obesity has become a common and serious condition in older adults. Exercise guidelines issued by the American College of Sports Medicine (ACSM) are authoritative in exercise science. For older adults with sarcopenic obesity, these guidelines provide multidimensional recommendations on exercise dose, including intensity, frequency, and duration for aerobic and resistance training.
To compare the effects of exercise doses with high adherence to ACSM recommendations versus those with low or uncertain adherence on body composition [body fat percentage, BMI, body weight, appendicular skeletal muscle mass (ASM) ] and physical function (grip strength and walking speed) in older adults with sarcopenic obesity.
Relevant studies on exercise interventions for older adults with sarcopenic obesity were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, Ovid, and China National Knowledge Infrastructure (CNKI). The search period was from database inception to 2023-12-26 for the first four databases, and from database inception to 2024-01-14 for Ovid and CNKI. Two investigators independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Study quality was evaluated using the risk-of-bias tool for randomized controlled trials, and Meta-analysis was performed using RevMan 5.4. Based on whether the intervention group's exercise dose adhered to ACSM recommendations, studies were classified as high adherence or low/uncertain adherence. The effects of these two exercise-dose categories on body fat percentage, BMI, body weight, ASM, grip strength, and walking speed were analyzed. Higgins I2 was used to assess heterogeneity among studies, and sensitivity analysis was performed by omitting one study at a time.
A total of 15 studies involving 810 participants were included, of which 7 studies had high adherence to ACSM recommendations and 8 had low or uncertain adherence. Eleven studies reported body fat percentage as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in body fat percentage (MD=-3.54, 95%CI= -5.65 to -1.44, P<0.05), whereas the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=-0.94, 95%CI=-2.54 to 0.67, P>0.05). Five studies reported BMI as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in BMI (MD=-1.98, 95%CI=-3.02 to -0.93, P<0.05). The low/uncertain-adherence intervention group also showed a reduction in BMI, but the difference was not statistically significant (MD=-1.72, 95%CI=-3.42 to -0.03, P=0.05). Five studies reported body weight as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in body weight (MD=-4.85, 95%CI=-7.84 to -1.86, P<0.05), while the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=-1.56, 95%CI=-5.94 to 2.81, P>0.05). Four studies reported ASM as an outcome. For both high-adherence and low/uncertain-adherence exercise doses, no statistically significant differences were observed in ASM compared with the control group (MD=-0.18, 95%CI=-1.03 to 0.67; MD=-0.05, 95%CI=-0.85 to 0.76, P>0.05). Eight studies reported grip strength as an outcome. Compared with the control group, the high-adherence intervention group showed a greater increase in grip strength (MD=2.86, 95%CI=0.76 to 4.97, P<0.05), whereas the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=3.04, 95%CI=-0.26 to 6.34, P>0.05). Seven studies reported walking speed as an outcome. The high-adherence intervention group improved walking speed more than the control group (MD=0.32, 95%CI=0.23 to 0.41, P<0.05), while the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=0.05, 95%CI=-0.01 to 0.11, P>0.05).
High-adherence exercise interventions had significant effects on improving body fat percentage, BMI, body weight, grip strength, and walking speed in patients with sarcopenic obesity. However, exercise intervention had no effect on ASM. Further studies are needed to verify these findings.
Functional dyspepsia (FD) is a common clinical disease with numerous guidelines and consensus, but the quality is uneven.
To explore current status of clinical guidelines and consensus of FD, evaluate and analyze their quality, and provide a reference for future clinical decision-making and guideline revision.
CNKI, Wanfang Data, VIP, PubMed, Web of Science, Ovid, and Embase were searched from the time of construction to March 30, 2024. Supplemental searches were conducted in databases and publishing platforms, including Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate guidelines network, National guideline clearinghouse, Medlive and Chinese Medical Association. The AGREEⅡand RIGHT checklists were used to evaluate the methodological and reporting quality of included studies by well-trained investigators with consistent understanding of the entries independently.
A total of 17 guidelines and consensus were included. The results of AGREEⅡquality evaluation showed that average scores for each of the 6 areas were scope and purpose (71.49±2.38)%, stakeholder involvement (42.48±5.03)%, rigour of development (36.00±5.88)%, clarity of presentation (60.29±5.05)%, applicability (20.47%±2.69%)%, and editorial independence 50.00% (0, 57.29%). 9 literatures were recommended as grade B, 8 literatures as grade C, and no A-rated literature. The results of RIGHT evaluation showed that average reporting rates for each of the seven areas were basic information (70.83±3.03)%, background (68.02±2.98)%, evidence 15.00% (10.00%, 55.00%), recommendation (36.76±3.21)%, review and quality assurance 0 (0, 6.25%), funding and declaration and management of interests (25.37±5.18) %, and other information 16.67% (0, 37.50%).
The overall methodological and reporting quality of clinical guidelines and expert consensus need to be improved, and it is recommended that guidelines should be written in strict accordance with the requirements of AGREE Ⅱand RIGHT checklist.
