The older adults are high risk population for malnutrition. Malnutrition is closely associated with numerous adverse clinical outcomes, which may seriously affect the physical health and life quality of the older adults, causing heavy burdens on families and society. Therefore, it is of great importance to take effective measures to improve malnutritionin the older adults, and non-pharmacological interventions have been proved to be important measures to improve nutritional status. However, there is no domestic clinical practice guideline for non-pharmacological interventions specifically for malnourished older adults. Therefore, nutrition experts from China Gerontological Nursing Alliance, National Center for Gerontology and National Clinical Research Center for Geriatric Disorders developed the guideline based on the Grading of Recommendation Assessment, Development and Evaluation (GRADE) including 9 recommendations of non-pharmacological intervention formal nourished older adults through a comprehensive search and analysis of the latest domestic and international literature on malnutrition in the elderly, in order to improve malnutrition and quality of life in the older adults. This guideline focuses on malnourished older adults who can be fed orally and enteral nutrition, parenteral nutrition is not covered by the scope of this guideline.
Evidence shows that coronavirus disease 2019 (COVID-19) can impact multiple bodily systems, with the cardiovascular system being commonly affected. In order to guide healthcare providers in diagnosing and managing cardiovascular issues related to COVID-19, the consensus group recommends: (1) Routine cardiac troponin testing is necessary for patients who are hospitalized or exhibit symptoms related to heart conditions after COVID-19 infection to evaluate potential myocardial injury and help detect any cardiac complications. Patients with myocardial injury not related to heart issues tend to have a poorer outcome. (2) Relatively few cases of acute myocarditis linked to COVID-19 have been reported, and individuals suspected of having myocarditis should be evaluated and managed based on risk stratification. (３) COVID-19 infection should be considered a risk factor for increasing the incidence of cardiovascular disease. All individuals who have been infected should adhere to a healthy lifestyle more strictly and implement appropriate primary or secondary preventive measures for cardiovascular disease. (4) For individuals who experience the persistence or emergence of new symptoms 3 months after the initial COVID-19 infection and have been experiencing these symptoms for at least 2 months, with no clear diagnosis of a cardiovascular disease through standard diagnostic tests, it is advisable to consider the possibility of "post COVID-19 condition". Rehabilitation should be given top priority for these patients.
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report) (GOLD 2023) maintains the basic framework of GOLD 2022, but with major revisions in the definition, assessment, initial therapy and follow-up management of chronic obstructive lung disease (COPD) as follow: (1) Chapter 1: The definition and overview section was rewritten to propose a new definition of COPD, incorporating new background information, therapeutic strategies and classifications for COPD, with the addition of content on chronic bronchitis; (2) Chapter 2: Content on screening and case-finding of COPD has been included, the ABCD assessment tool has been revised to the ABE assessment tool (no further grouping of high-risk population of acute exacerbation of COPD based on symptom levels), information on imaging and computed tomography scans (CT) has been included in the diagnosis and assessment section; (3) Chapter 3: Recommendations for Streptococcus pneumoniae vaccination have been updated, information on therapeutic interventions to reduce COPD mortality has been included, issues related to inhalation delivery have been updated, content on inhaled medications adherence and remote rehabilitation has been included, information on interventional and surgical therapies of COPD has been expanded in the prevention and maintenance treatment section; (4) Chapter 4: Information on the selection of inhalation devices has been included, information on initial drug therapy and follow-up drug therapy has been updated in the management of stable COPD section; (5) Chapter 5: A new definition of and set of acute exacerbation of COPD assessment parameters have been proposed, information on differential diagnoses of acute exacerbation of COPD has been expanded in the acute exacerbation of COPD section management; (6) Chapter 6 and 7: Updating content on COPD and complications (Chapter 6), COPD (Chapter 7) and COVID-19 based on the latest evidence. The above updates will be an important guide to the clinical management of COPD.
At the end of 2014, the department of policies, regulations and supervision of the State Administration of traditional Chinese medicine carried out started to the preparation development and revision of clinical diagnosis and treatment guidelines of traditional Chinese medicine at the end of 2014, and made progressdeveloped in 240 clinical diagnosis and treatment guidelines of traditional Chinese medicine in 13 specialized fields. The Chinese society of traditional Chinese medicine undertookakes this part of the work.
In order to understand the current situation of the preparation development and revision of clinical diagnosis and treatment guidelines for in the field of traditional Chinese medicine, analyze the problems existing in the work of thethis project team from the perspective of methodology and give suggestions, this project team conducted investigated research on the preparation development and revision project team of clinical diagnosis and treatment guidelines of developed by traditional Chinese medicine of the Chinese Academy of traditional Chinese medicine.
The survey will be conducted from June to December 2020. The survey object participants are is the project groups of the preparation development and revision of the clinical diagnosis and treatment guidelines of Chinese medicine of the Chinese Society of Traditional Chinese Medicine. Each project team member of this project team finishedlls in a questionnaire, and finally gathers the overall opinions of the project team were collected. The Chinese Society of Traditional Chinese Medicine issued a notice to invite all project teams to participate in the survey by means ofusing questionnaire star electronic questionnaire, and finally collected the answers on the network. Focusing Based on the research theme, the questionnaire includes five aspects: 1. understanding of the clinical diagnosis and treatment guidelines of for traditional Chinese medicine; 2. guide preparation development and revision procedures and application of methodology application; 3. key issues and key links steps in the preparation development and revision of the guidelines; 4. implementation, promotion and application of the guidelines; 5. overall investigation on about the guidelines preparation development and revision of the guidelines. The questionnaire is semi-structured, with 30 structured questions and 4 open questions. After the completion of the survey, the researchers conducted data summary and descriptive analysis on the results after survey.
The survey finally recovered collected 198 valid questionnaires. The survey results suggest that most project teams (94.45%, 187/198) think that more clinical diagnosis and treatment guidelines of for traditional Chinese medicine are still needed in this field, and the coverage of clinical diagnosis and treatment guidelines of traditional Chinese medicine is still not wide enough, and the clinical application is poor; In terms of the procedures for the preparation development and revision of the guidelines and the application of methodology application, 99.49% (197/198) of the project teams followed the technical plan for the preparation development and revision of the guidelines, and 99.49% (197/198) of the project teams had methodological experts participating in the whole process. In terms of the key issues and key linkssteps in the preparation development and revision of the guidelines, most project teams believed that the main difficulties difficulties mainly focus on theare lack of high-quality clinical research evidence support (89.39%, 177/198), the lack of methodological tools consistent with the characteristics of traditional Chinese medicine (70.20%, 139/198), the difficulty in unifying clinical classification standards (66.16%, 131/198), and the absence of fixed standards for the selection and dosage of prescriptions and drugs (60.61%, 119/198). In terms of the implementation, promotion and application of the guidelines, 71.21% (141/198) of the project team believed that the promotion and application were in line with expectations, but there were also some difficulties in promotion and application; In terms of overall research investigation on about the preparation development and revision of the guidelines, the vast majority (96.97%, 192/198) of the project teams said that they had invested a lot of human, material, energy and other resources in the preparation development and revision of the guidelines.
Most project teams thought clinical diagnosis and treatment guidelines for traditional Chinese medicine had significant guidance in clinical practice, and each project team face some problems and difficulties in guideline development and revisions. We give proposed the following suggestions: in the future, attention should be paid to the preparation development and revision of the guidelines, and relevant financial support should be increased; during the preparation development and revision of clinical diagnosis and treatment guidelines of traditional Chinese medicine, all working groups need to have methodological experts participate in the whole process and control the quality; increase training on evidence-based medicine and the formulation of clinical diagnosis and treatment guidelines; strictly follow the latest technical solutions and methodological processes; during the preparation development and revision of the guidelines, we should pay attention to the characteristics of traditional Chinese medicine diagnosis and treatment, and aim at clinical practicality and applicability, in order to improve the quality of clinical diagnosis and treatment guidelines of traditional Chinese medicine and promote traditional Chinese medicine to better serve people's health.
Neck pain is often caused by cervical degenerative diseases, which is easy to cause adverse effects on neck function and quality of life of patients. To provide the best and effective diagnosis and treatment plan, the National University of Health Sciences published its evidence-based clinical practice guidelines for neck pain in 2019. The author in fully study the latest version guidelines on the basis of diagnosis and treatment content, from the diagnosis, treatment, matters needing attention in three aspects, and search the relevant literature research longitudinal contrast multiple high quality neck pain guidelines, from the biomechanics and neurobiological analysis of scientific treatment, and combined with the analysis of Chinese diagnosis and treatment status that the recommended treatment and treatment process is feasible in China, based on this that should through existing evidence-based medical evidence combined with Chinese Traditional Medicine guide clinical practice, hope to reference to domestic clinical treatment today.
Degenerative lumbar spinal stenosis (DLSS) is a costly disease that mainly occurs during the old age, which seriously affects the normal life. There are many treatment options for DLSS. The development and clinical application of high-quality clinical practice guidelines are major ways to improve the diagnosis and treatment of DLSS.
To provide a reference for the development and reporting of clinical practice guidelines of DLSS, with guidelines of DLSS evaluated using AGREEⅡ and RIGHT, from the perspectives of methodology and quality.
Databases were searched for clinical practice guidelines, consensuses and specifications about DLSS, including CBM, CNKI, Wanfang Data, VIP, PubMed, Medlive, WHO, the National Institute for Health and Care Excellence, Guidelines International Network, National Guideline Clearinghouse and Scottish Intercollegiate Guideline Network from January 1, 2010 to January 1, 2022. The methodological quality and reporting quality of included studies were evaluated by two raters independently. And the recommendations in the studies were compared under the uniform grading criteria.
Six studies were enrolled, including four guidelines and two consensuses. One guideline is based on TCM, and the other three are evidence-based guidelines. The evaluation results of AGREEⅡ showed that the ratio of the actual total score to the full score of the six included studies was 78.2%, 53.6%, 45.7%, 37.7%, 28.2% and 15.0%, from highest to the lowest. RIGHT evaluation showed that the ratio of the actual total score to the full score of the four guidelines was 72.9%, 72.9%, 62.9% and 34.3%, from highest to the lowest. A total of 46 therapeutic and 11 non-therapeutic recommendations were developed in the six studies.
The methodological quality and reporting specification of the present DLSS guidelines and consensuses require to be further improved. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the process of guideline development and reporting. Surgical treatment is the preferred recommendation for patients with moderate or severe DLSS.
In China, idiopathic membranous nephropathy (IMN) accounts for 24.9% of glomerular diseases, the second highest share, and is increasing year by year. Chinese medicine has been widely used in the clinical practice of IMN. However, there are no evidence-based practice guidelines for the treatment of IMN with Chinese medicine. This guideline followed the methods and steps of the guideline development manual. The level of the body of the evidence was assessed by the GRADE. An outline of the clinical questions was formulated through interviews with leading Chinese medicine experts and a review of relevant clinical guidelines. Based on the results of a systematic review of authoritative textbooks and clinical research literature, a clinical question list, a clinical outcome assessment index for IMN, and a list of types of Chinese medicine syndromes were developed, and a national expert survey was conducted to identify the clinical questions included in this guideline. A consensus meeting was held to finalize 10 recommendations for treating IMN with Chinese medicine. This guideline focuses on the clinical practice of Chinese medicine in the treatment of IMN, and is applicable to all levels of Chinese medicine and integrated Chinese and Western medicine institutions, as well as medical institutions and healthcare workers who provide Chinese medicine services.
Trazodone hydrochloride sustained -release, as a multi-receptor binding drug, can exert different pharmacological effects at different doses and can improve a variety of psychiatric disorders. To further standardize the clinical application of trazodone hydrochloride sustained release, the expert writing group integrated domestic and international clinical trials, clinical practice guidelines, prescribing guidelines and clinical medication experience to prepare this expert recommendation for clinical application. This article mentions that trazodone hydrochloride sustained release is clinically applicable to depression, insomnia caused by various reasons, and also applied to generalized anxiety disorder, sexual dysfunction, post-traumatic stress disorder, substance dependence and withdrawal reactions and obsessive-compulsive disorder, and describes drug dosage, interactions, and precautions for use in special populations, with a view to providing clinicians with scientific and comprehensive medication guidance.
Schizophrenia is a chronic, recurrent and disabling psychotic disorder. Enhancing patient adherence and preventing recurrence are the key factors of treating schizophrenia, and the core determinants of prognosis and social functional recovery of these patients. Recommended by guidelines/consensuses as one treatment for schizophrenia, long-acting injectable (LAI) antipsychotics have been an important intervention for treating schizophrenia and for preventing its recurrence. At the same time, as community settings are important sites for the rehabilitation of schizophrenia, considerable efforts have been made to explore models of community-based management of schizophrenia. Currently, the use of LAI antipsychotics in community-based management of schizophrenia has been highlighted in multiple policies and documents of China, but its application is negatively influenced partially by community physicians' insufficient understanding and application skills regarding LAI antipsychotics, which has become a bottleneck that hinders the comprehensive rehabilitation of schizophrenics. In view of this, a consensus was developed based on clinical evidence, previous guidelines and consensuses, expert individual practice and features of community settings in China, by a group of 13 experts, including psychiatrists from the Chinese Schizophrenia Coordination Group, Chinese Society of Psychiatry, and general medicine experts from the Chinese Society of General Practice. This consensus will significantly contribute to the solving of problems in the use of LAI antipsychotics for community-based management of schizophrenia, and the improvement of patient adherence and prognosis.
China has attached importance to the prevention and treatment of chronic obstructive pulmonary disease (COPD) , a major chronic respiratory disease. An in-depth discussion of the immunopathogenesis of COPD and intervening the identified key targets may be new ideas for the prevention and treatment of COPD. Based on the relevant evidence of commonly used immunomodulatory agents for COPD, and the status and trend of development of immunomodulators for COPD, the Writing Group for the Expert Consensus of Immunemodulatory Therapies for Chronic Obstructive Pulmonary Disease proposed the following four recommendations for treating COPD with immunomodulatory therapies: (1) bacterial lysates, phosphodiesterase inhibitors, macrolides and other biological and chemical agents have immunomodulatory efects on COPD by enhancing immune function and immune cell activity; (2) vaccination against influenza and pneumococcal infection could reduce the probability of acute exacerbation of COPD and mortality; (3) statins and vitamin D may be partially effective in COPD owing to their immunomodulatory actions, but need to be verified further due to quite insufficient relevant evidence and reported adverse reactions; (4) Chinese medicine compound and Cordyceps preparations may improve the quality of life and reduce the probability of acute exacerbationsin patients with stable COPD by regulating immune function and improving immune cell activity.The main purpose of this consensus is to greatly promote the clinical treatment of COPD using immunomodulatory therapies in China.
Diabetes is a serious public health problem worldwide. The prevalence of chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (T2DM) is growing with the increase of T2DM prevalence. There is no comprehensive guideline on medication safety in polypharmacy in patients with T2DM-related CKD. This consensus provides guidance on safety issues in polypharmacy for clinical pharmacists and Chinese patients with T2DM-related CKD, and a summary of the information on usage and dosage, and related pharmaceutical characteristics of drugs as well as medication for special populations for supporting clinical medical workers in delivering standardized medication services.
Chinese Consensus on Diagnosis and Assessment of Sleep Apnea Syndrome in Older Adults
It is a necessary trend to improve the quality of life of rapidly increasing number of older adults. Sleep disorders are significantly associated with the quality of life in older adults, among which sleep apnea syndrome (SAS) is second only to insomnia, which is an inducer of multiple diseases, and directly associated with many chronic diseases, such as cardiovascular and cerebrovascular diseases, Alzheimer's disease, metabolic abnormalities, respiratory diseases, even leads to sudden death. So SAS in older adults should be given great attention by the whole society. With this in mind, the Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society invited Chinese sleep medicine experts to develop a consensus on the classification, risk factors, clinical symptoms, diagnosis and assessment methods, diagnostic procedures as well as complications of SAS in older adults based on a review of relevant clinical studies, aiming to provide a reference for the standardization of SAS diagnosis and assessment in China.
Interpretation of Global Strategy for the Diagnosis，Treatment，Management and Prevention of Chronic Obstructive Pulmonary Disease 2022 Report
Global initiative for chronic obstructive lung disease (GOLD) 2022 report was released on November 15, 2021. In general, chronic obstructive pulmonary disease (COPD) diagnosis, assessment and individualized therapy are the same as GOLD 2021, with corresponding content added in ten aspects. The article introduces and interprets the new content.
