Due to the accelerating trend of aging and transformation of residents' lifestyles and behaviors in China, multiple chronic conditions have become a major public health challenge. The phenomenon of comorbidities complicates patients' conditions and poor nutritional status, causing a heavy burden on patients' health and society. In 2018, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the ESPEN Guidelines on Nutritional Support for Polymorbid internal medicine patients, which provides 22 recommendations and four statements on nutritional screening, assessment, requirements, monitoring and procedure of intervention for polymorbid medical inpatients. Based on continuously updated research evidence, the 2018 version of the guideline was updated by the ESPEN Guideline Working Group in June 2023, ESPEN Guideline on Nutritional Support for Polymorbid Medical Inpatients, to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. This article interprets and focuses 15 key points of the guideline, include nutritional screening and assessment, oral nutritional supplements, enteral nutrition and parenteral nutrition, estimation of energy requirements, protein targets, micronutrients supplementation, disease-specific nutritional supplementation, early nutritional support, post-discharge nutritional support, monitoring of physical functions, energy and protein requirements, organizational changes in nutritional support, impact of underlying diseases on nutritional support, drug-nutrient interactions and nutritional biomarkers. In order to provide guidance for nutritional management of polymorbid patients in China.

Chronic coronary disease (CCD) refers to chronic heart or vascular disease caused by insufficient blood flow into or out of the heart. The incidence and mortality rates of CCD are high, resulting in significant personal, economic, and societal burdens. In July 2023, the American Heart Association (AHA) and the American College of Cardiology (ACC), along with other academic organizations, jointly released the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease. This guideline provides a on the evidence-based and patient-centered approach to comprehensive management of patients with CCD. It covers the epidemiology of CCD, patient assessment, diagnosis, risk stratification, treatment, management of special populations, patient follow-up, and related considerations. The guideline emphasizes the importance of a healthy diet, regular physical exercise, and tobacco avoidance for cardiovascular health. It also updates the recommendations for the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) and provides the latest evidence-based recommendations for clinical practice. This article provides a key interpretation of the management strategies outlined in the guideline, aiming to provide a basis for the development and update of relevant guidelines in China. The goal is to standardize and improve the specialized diagnosis and care for patients with CCD, with the ultimate aim of providing evidence-based guidance for clinical practice and improving the prognosis of patients with CCD.

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.

Anxiety disorders are the most common mental illnesses and are often overlooked in primary care settings, with delays in initial treatment and significant impairment on patients' social function and quality of life. In 2023, the U.S. Preventive Services Task Force (USPSTF) published a recommendation statement on adult anxiety disorder screening in JAMA, along with the latest evidence report and systematic review results. The USPSTF suggests screening for anxiety in adults, including pregnant and postpartum women. However, current evidence on the risks and benefits of screening for anxiety in older adults is insufficient to determine the pros and cons of screening. This article combines the USPSTF statement with domestic and international research to provide an overview of several aspects: the current state of adult anxiety disorders domestically and internationally, a summary of the USPSTF recommendation statement, risk factors, early screening tools and their pros and cons, treatment, and the value of the statement for general practice guidance.

Chronic obstructive pulmonary disease (COPD) is a common disease that seriously harms human health, and it is also a leading cause of death, with a large number of cases being underdiagnosed. Can COPD screening enable early diagnosis of the disease and improve patient outcomes? In 2022, the U.S. Preventive Services Task Force (USPSTF) updated its "Chronic Obstructive Pulmonary Disease Screening Recommendation Statement" (hereinafter referred to as the "Recommendation") for asymptomatic adults by evaluating the latest research evidence regarding the benefits and harms of COPD screening. Based on limited evidence, the USPSTF issused a 'D' statement (there is moderate certainty that the screening has no net benefit) and recommends against COPD screening for asymptomatic adults, which is consistent with the 2016 version. The current article interprets the principles of this Recommendation in the context of Chinese general practice.

In 2022, the U.S. Preventive Services Task Force (USPSTF) updated its recommendations, reviewing the evidence of the benefits and harms of behavioral counseling interventions aimed at promoting healthy behaviors in adults without cardiovascular disease risk factors. The conclusions of this review align with the 2017 guidelines. Behavioral counseling interventions in adults without cardiovascular disease risk factors result in minimal net benefits. Therefore, it is recommended that clinicians make individualized decisions on whether to provide or recommend behavioral counseling interventions to adults without cardiovascular disease risk factors to promote a healthy diet and physical activity (Grade C). This article provides a comprehensive interpretation of the guidelines in the context of the current status of cardiovascular disease prevention in China, offering valuable insights into cardiovascular disease prevention practices among Chinese adults.

Global initiative for chronic obstructive lung disease (GOLD) 2024 report was released on November 13th, 2023. In general, the definition, diagnosis, assessment, and therapy of chronic obstructive pulmonary disease (COPD) are the same as GOLD 2023, with corresponding content added in ten aspects, including the expansion of the information about PRISm, a new section on hyperinflation, further clarification about pre-bronchodilator spirometry, a new section on screening for COPD in targeted populations, the update of blood eosinophil count, the update of interstitial lung abnormalities, the revision of the section on smoking cessation, the update of vaccination recommendations for people with COPD, the expansion of managing inhaled therapy, and the addition of pharmacotherapies for smoking cessation. The article introduces and interprets the new contents.

Depression and suicide in adults have become significant public health issues in China and globally, imposing a heavy burden on patients and society. In 2023, the United States Preventive Services Task Force (USPSTF) published a recommendation statement on Screening for Depression and Suicide Risk in Adults in JAMA. The statement suggested screening for depression in adults, including pregnant and postpartum individuals, as well as the elderly. However, the evidence regarding the risks and benefits of suicide screening is insufficient, making it challenging to determine its overall impact. This article provides an overview of adult depression and suicide, including epidemiology, risk factors, early screening tools, pros and cons, treatments and interventions, and the guidance value of the USPSTF statement for general practitioners, combining insights from the USPSTF statement and current research both domestically and internationally.

Dyslipidemia due to genetic and multifactorial dyslipidemia has a predisposition to early-onset atherosclerotic cardiovascular disease (ASCVD), and consensus and guidelines regarding lipid lowering in adults are well established, but the benefits of lipid screening and treatment in childhood and adolescence for this population are not well established. The United States Preventive Medicine Task Force (USPSTF) issued the Recommendation Statement: Screening for Dyslipidemia in Children and Adolescents based on a systematic review of evidence with meta-analysis conducted in a large number of randomized controlled trials, large cohort studies in European and American countries, with the aim of assessing evidences whether initiation of lipid screening and early initiation of treatment in childhood and adolescence has long-term benefits for this population. This article provides a detailed interpretation of the guideline, which aims to provide reference to clinical healthcare workers to improve the understanding of dyslipidaemia in children and to decide whether to screen them with a view to reducing the incidence of cardiovascular disease in adulthood.

Cardiovascular disease (CVD) is one of the leading causes of death worldwide. In April 2022, the U.S. Preventive Services Task Force (USPSTF) updated and published recommendations on aspirin use to prevent CVD based on the latest evidence-based research results. The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults aged 60 years and above. The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one based on shared decision-making between clinicians and patients about the potential benefits and harms. This paper aims to interpret the latest recommendations in the context of China's actual situation, providing a reference on aspirin use to prevent CVD in China.

Lung cancer is the most leading cause of global cancer mortality, underscores the critical importance of early screening and intervention to improve the prognosis and survival time and the overall survival rates of patients. For decades, lung cancer screening guidelines have been continuously updated based on the developed evidence. The U.S. Preventive Services Task Force (USPSTF) has comprehensively updated the recommendations for lung cancer screening in the 2021 version of guideline, assessed the balance of benefits and harms of lung cancer screening through a systematic review and collaborative modeling studies, and scrutinized the performance of tests using low-dose computed tomography (LDCT) for lung cancer screening. The guideline provides latest information on the start and finish time of lung cancer screening, optimal screening intervals, the relative benefits and risks of different screening strategies and updated recommendations. This article aims to interpret the updated guideline and provide recommendations for lung cancer screening in China, taking into account the epidemiology of lung cancer at home and abroad, reports on risk factors, summaries of updates to current guidelines or expert consensus, and the current status of screening.

Cardiovascular disease (CVD) is the leading cause of death. It is well known that statins can reduce the risk of CVD and CVD-related death through lipid-lowering, anti-inflammatory, and plaque-stabilizing effects. In August 2022, the U.S. Preventive Services Task Force (USPSTF) conducted an updated recommendations statement on statins for primary prevention of CVD based on new evidence on the benefits and potential harms of statins in reducing CVD morbidity/mortality and all-cause mortality. The USPSTF recommends statins for the primary prevention of CVD for adults aged 40 to 75 years with 1 or more CVD risk factors and an estimated 10-year CVD risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer statins for the primary prevention of CVD in adults aged 40 to 75 years who have 1 or more of CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using statins for primary prevention of CVD events and mortality in adults aged 76 years and above (I statement). This article interprets the latest recommendations in the context of China to provide reference for the use of statins for the primary prevention of CVD in China.

Obstructive sleep apnea hypopnea syndrome (OSAHS) in adults is a common sleep-breathing disorder closely associated with hypertension, diabetes, cardiovascular diseases, and other health concerns. Despite its widespread impact on global health, the screening and diagnosis of OSAHS is still not widely available in clinical practice. In this context, the U.S. Preventive Services Task Force (USPSTF) has recently released updated recommendations for adult OSAHS screening to help more people identify and treat potential sleep-breathing disorders. This article interprets the latest recommendations and consider the practical situation in China, providing reference for OSAHS screening of adults in China.

At a time when healthcare reforms are being implemented in the new era, the scientific research output in the field of general practice and primary care in China has grown rapidly in recent years. However, the methodological quality of the literature is unclear.

To evaluate the methodological quality of representative quantitative studies and systematic reviews/guidelines in the field of general practice and primary care in China in 2021, to reveal the overall methodological quality characteristics of scientific papers in this field.

A sample of 449 papers was selected from a total of 3 122 papers collected in the Primary Care and General Practice Research Paper Productivity Report in China in 2021. A methodological quality assessment group consisting of 22 researchers in the field of public health and general practice from different institutions was organized to evaluate the quality of 320 of these papers (71.3%) using six different quality assessment tools for different study designs (cross-sectional studies, cohort studies, pre- and post-intervention studies, randomized controlled trials, systematic reviews, guidelines and consensus) by working in pairs and under the training and guidance of an expert in evidence-based medical methodology. Descriptive statistics method was used to report the overall quality assessment results of the various types of research papers.

Of the 114 cross-sectional research papers, quality issues were prevalent in the areas of "whether the source population was representative of the study's target population" (41.2%) , "whether the reliability and validity of the survey instrument could be conclusively demonstrated" (32.5%) , "whether the survey is clinically meaningful" (26.3%) ; of the 25 cohort study papers, quality issues were more concentrated in the areas of "whether the cohort was adequately followed up" (44.0%) and "whether the co-intervention was similar among groups" (56.0%) ; of the 34 pre- and post-intervention studies, quality issues were mostly found in the areas of "whether the target outcome was measured multiple times before and after the intervention" (97.1%) , "whether the sample size was large enough to generate confidence in the study results" (82.4%) , and "whether the study participants were representative of the eligible population" (61.8%) ; of the 122 randomized controlled trials, quality concerns were mostly in the areas of "blinding of different stakeholders" (25.4%-61.5%) , "adequate concealment of random allocation" (41.8%) , and "other risks of bias" (72.1%) ; of the 19 systematic reviews, quality issues were mostly found in the areas "is the source of funding for the included studies reported" (100.0%) , "were the methods of the review developed before the start of the review" (94.7%) , "was heterogeneity reasonably discussed and explained" (84.2%) , and "was the risk of bias of individual studies considered" (84.2%) . Finally, the quality of all six clinical guidelines/consensus was rated low.

The scientific research output of recent years in the field of primary care and general practice in China is still of limited quality in general, which is particularly evident in the categories of cross-sectional studies, pre- and post-intervention studies, randomized controlled trials, guidelines and consensus. This highlights the urgency and importance of strengthening systematic training in basic research in this area of research in China, increasing the importance of research and evidence-based reporting standards, and developing pragmatic methodological specifications for the development of guidelines.

Pituitary prolactinoma is a neuroendocrine disease caused by excessive pituitary prolactin-cell adenoma synthesis and prolactin secretion. The standardized diagnosis and treatment of pituitary prolactinoma in of great significance for recovering and maintaining pituitary function and improving life quality of the patients. In January 2022, the International Chapter of Clinical Endocrinology (ICCE) and the Italian Association of Clinical Endocrinologists (AME) published a position statement on pituitary prolactinoma in the European Journal of Endocrinology: 2022 ICCE/AME Position Statement for Clinical Practice in Pituitary Prolactinoma (abbreviated as 2022 ICCE/AME position statement) . Based on the latest medical evidence, 2022 ICCE/AME position statement conducts a systematic review, analysis and recommendations on the clinical diagnosis and treatment of pituitary prolactinoma. This article provides an update on the diagnosis and treatment of pituitary prolactinoma, special populations, dopamine agonist resistance, and invasive prolactinoma in the 2022 ICCE/AME position statement, which is hoped to be helpful to the awareness of pituitary prolactinoma among general practitioners and endocrinologists, and provide a reference for the clinical practice of standardized diagnosis and treatment.

Primary care physicians (PCPs), who play a crucial role in providing primary healthcare services, utilize clinical practice guidelines as valuable tools for guiding their practice. By investigating these physicians' awareness and usage of guidelines, we can offer innovative strategies for promoting guideline adherence and enhancing physicians' training. This, in turn, can ultimately improve the quality of primary healthcare.

To explore the level of awareness and the current status of reference use of traditional Chinese medicine (TCM) guidelines for diabetes among PCPs, and to identify the influencing factors.

From September 22 to October 29, 2021, an online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians. The questionnaire consists of three parts: basic information, current status and needs of physicians in using TCM for diabetes prevention and treatment, and a survey on physicians' current awareness and needs regarding diabetes guidelines. Ordered multiclass Logistic regression analysis was used to identify the influencing factors of PCPs' awareness and usage of TCM guidelines for diabetes.

A total of 382 questionnaires were collected from PCPs, 35.34% (135/382) of the physicians were very familiar or fairly familiar with TCM guidelines for diabetes, while 28.80% (110/382) of the physicians referred to these guidelines regularly for diabetes management. The results of the univariate analysis showed that, PCPs with differences in gender, specialty, department, number of diabetic patients treated per week, evaluation of TCM treatment efficacy, availability of TCM herbs and Chinese patent drugs in physicians' institutions, and physicians' awareness of guidelines, showed statistically significant differences in their reference status of TCM guidelines for diabetes (P<0.05). The results of the ordered multinomial Logistic regression analysis showed that, the factors influencing PCPs' awareness of TCM guidelines for diabetes included PCPs' evaluation of TCM treatment efficacy (OR=5.783, 95%CI=1.283-26.102), availability of TCM herbs and Chinese patent drugs in physicians' institutions (OR=2.399, 95%CI=1.548-3.717), and their previous participation in specialized training on diabetes prevention and control guidelines (OR=1.751, 95%CI=1.149-2.667). The factors influencing PCPs' reference to TCM guidelines for diabetes included the physicians' level of familiarity with the guidelines [very or fairly familiar (OR=15.721, 95%CI=7.584-32.557), somewhat familiar (OR=5.392, 95%CI=2.841-10.237) ], work experience less than 5 years (OR=14.083, 95%CI=1.390-142.594), different specialties [TCM (OR=6.869, 95%CI=1.483-31.849), integrated Chinese and western medicine (OR=6.613, 95%CI=1.551-28.219) ], and geographical regions [northeast (OR=2.962, 95%CI=1.064-8.240), southeast (OR=2.686, 95%CI=1.004-7.178) ].

The awareness and reference usage of TCM guidelines for diabetes among PCPs need to be improved. Factors such as guideline awareness, work experience, professional orientation, and geographical region play a significant role in influencing physicians' utilization of the guidelines. In the future, training for PCPs should be strengthened, particularly focusing on the northwest and southwest regions, and PCPs with a background in TCM should receive more training on TCM-related guidelines for diabetes prevention and treatment.

Anorexia nervosa (AN) is a type of eating disorders characterized by self-starvation, significant loss of body mass, and malnutrition. AN has the highest mortality rate among all psychiatric disorders, leading to severe psychopathologic symptoms and life-threatening medical complications. However, AN cannot be recognized and diagnosed early in China, resulting in a prolonged course of the 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, this expert consensus was formulated by 16 medical experts based on evidence-based medical evidence, domestic and international guidelines and expert consensus, expert experience, etc., in order to improve the recognition, diagnosis and treatment of AN among domestic professionals.

Insomnia is the most common sleep disorder, which not only causes individual health damage, but also brings heavy social and economic burden. The traditional insomnia treatment model has the disadvantages of complicated process and high cost. With the development of information technology, the more convenient and low-cost digital therapy for insomnia (DTI) has been increasingly utilized. However, there is still a lack of standardized guidelines for DTI globally. To address this issue, the China Sleep Research Society collaborated with domestic experts in sleep medicine and medical engineering to develop the Expert Consensus on Digital Therapies for Insomnia in China, elaborates on the definition, indications, core principles, research and development, promotion and application, education and training, data protection, ethical supervision, aiming to establish a unified and comprehensive framework for DTI.

Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHCs) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization's mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China's emergent mental health system.

A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either "somewhat agree/definitely agree", or "definitely disagree/somewhat disagree" on a five-point scale for agreement.

79% of statements received consensus with a mean score of 4.26 (i.e. "somewhat agree"). Agreed adaptations for mhGAP-IG.v2 included: an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians' roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide.

An adapted mhGAP-IG.v2 for depression recognises China's cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries.

The incidence of psychiatric dizziness is high. If clinicians do not have enough knowledge about it, they are prone to misdiagnose psychiatric dizziness as posterior circulation ischemic attack, cervical dizziness, vestibular peripheral vertigo or other diseases, thus leading to inappropriate examinations and treatments. With the increasing emphasis on psychosomatic diseases, the Holistic Health Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association formulated the Chinese Expert Consensus on Diagnosis and Treatment of Psychiatric Dizziness in combination with the latest evidence in relevant fields at home and abroad, as well as the opinions of experts in psychosomatic health, mental disorders, vertigo and other fields. This consensus elaborated the concept, etiology and pathogenesis, clinical characteristics, diagnosis and evaluation, and various treatment approaches of psychiatric dizziness, and formulated the final expert consensus after multidisciplinary expert communication, aiming to provide a reference basis for standardized diagnosis and treatment of psychiatric dizziness.

Clinically, patients with cardiovascular disease widely have psycho-psychological problems, which interact with each other and aggravate the disease state. Psycho-cardiology is a discipline formed by the intersection and integration of cardiology and psychology, which emphasizes the attention to cardiovascular diseases and the mental state of patients. Experts from the Psycho-cardiology Group of the Psychosomatic Medicine Society of the Chinese Medical Association formulated Chinese Expert Consensus on the Construction Standardization of Psycho-cardiology Outpatient after reviewing literature and conducting discussions, in order to improve the diagnosis and treatment capacity of psycho-cardiology in China, promote medical institutions at all levels to set up psycho-cardiology outpatient, and continuously improve the medical service system of psycho-cardiology in China.

Bulimia nervosa is a type of eating disorders characterized by recurrent binge eating and compensatory behaviors to prevent weight gain, as well as excessive concern about body shape and mass. The patients with bulimia nervosa present with disturbed eating behavior, resulting in electrolyte abnormalities, gastrointestinal disorders, metabolic and endocrine disorders and other physical problems; secondly, the bulimia nervosa patients are often co-morbid with a variety of mental disorders such as bipolar disorder, depression, substance use disorders, which need to be taken seriously. However, bulimia nervosa and even eating disorders cannot be recognized and diagnosed at an early stage in China, which leads to a prolonged course of the disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, in conjunction with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, this expert consensus was formulated by 12 experts in the field of psychiatry and evidence-based medicine based on evidence-based medicine, domestic and foreign guidelines and expert consensus and expert experience, in order to improve the recognition, diagnosis and treatment of bulimia nervosa by psychiatric professionals and general practitioners in China.

Chronic obstructive pulmonary disease (COPD) is one of the major chronic disease seriously affecting the health of Chinese residents. There are national and international guidelines and consensus on the diagnosis, treatment and management of COPD. However, there is no expert consensus on integrated traditional Chinese and western medicine management for COPD by now. Therefore, Chinese and western medicine experts with rich experience in the diagnosis and treatment of COPD in China were invited to formulate this consensus based on relevant domestic and foreign guidelines, consensus and personal experience, which includes early recognition and diagnosis of COPD, disease assessment, integrated traditional Chinese and western medicine treatment for stable COPD, evaluation, intervention measures of traditional Chinese and modern medicine, follow-up and management of acute exacerbation of COPD, so as to further improve the level of diagnosis, treatment and management of COPD in China.

Lumbar spinal stenosis (LSS) is a common disease in orthopedics. The American Society of Pain and Neuroscience (ASPN) published a new version of minimally invasive treatment practice guidelines in 2022 to improve the clinical efficacy of LSS. A total of seven treatments for LSS were included in the guidelines, including percutaneous image-guided lumbar decompression (PILD), interspinous spacers (ISP), interspinous fusion (ISF), intrathecal drug delivery systems (IDDS), spinal cord stimulation (SCS), epidural steroid injections (ESI) and open decompression. Based on the guidelines, this paper summarizes and discusses the research progress of minimally invasive treatment of LSS in the context of the clinical situation, aiming to provide a reference for clinicians and further related researches.

Perinatal mental disorders are one of the most common disorders during pregnancy and may lead to adverse maternal and offspring outcomes. There is an increasing number of women currently at risk for emotional problems such as anxiety and depression during pregnancy and childbirth, and women with previous mental disorders are also at risk of relapse during pregnancy. At the same time, the lack of clinical guidelines for the diagnosis and treatment of perinatal mental disorders has made the work of clinicians even more challenging. The expert writing group integrated the latest medical evidence and clinical practice in related fields at home and abroad to form the expert consensus, consisting of the epidemiology and pathogenesis, clinical manifestations, clinical evaluation, diagnosis, treatment and management of perinatal mental disorders, which can provide reference and guidance for practical clinical work. The consensus advocates comprehensive, whole-process, hierarchical, multidisciplinary and collaborative diagnosis and treatment, to help frontline clinicians screen, rationally assess and clinically diagnose perinatal pregnant women as soon as possible, as well as provide necessary psychological interventions and clinical medication for them.

Regular physical activity is a cornerstone of diabetes management, and more precise guidance on exercise prescriptions is needed in children and adolescents with diabetes due to the complexity of glycemic changes, however, there are relatively few guidelines for this population. As the continuous exploration of experts and scholars in this field, after five years, the International Society for Pediatric and Adolescent Diabetes (ISPAD) updated its guidelines on exercise for children and adolescents with diabetes in 2022. The guidelines target the service population more precisely to the children and adolescents with type 1 diabetes and provide comprehensive guidance from the perspectives of exercise types, exercise timing, blood glucose fluctuations during exercise, insulin adjustment and nutritional supplementation. This article interprets the main contents and key updates of the 2022 ISPAD guidelines, aiming to provide more scientific exercise prescriptions for children and adolescents with diabetes in China.

In order to standardize scientific drug use in vertigo, the Vertigo Committee of the Chinese Medical Education Association established an expert group to form Expert Consensus on Betahistine Mesylate in the Treatment of Vertigo after repeated discussion based on the existing medical evidence, and combined with the rich clinical experience of experts. The consensus includes the pharmacological basis of histamines, the strength of recommendation, dosage, course, review methods, medication for special populations, adverse drug reactions and other aspects of betahistine mesylate in common vertigo diseases (such as benign paroxysmal position vertigo, Menieres disease, and vestibular neuritis, etc.) to guide doctors in clinical work.

With the prosperous development of Internet medical care and increasing flow of electronic prescriptions, electronic prescription review has become an important guarantee for rational drug use in the online medication environment. However, in the Internet scenario, inefficient manual review with low quality increases the risk of adverse drug events. The application of the intelligent auxiliary prescription review system can significantly reduce the working pressure of pharmacists reviewing prescriptions and improve the efficiency of review, but there is a lack of setting standards and standardized management measures in the system architecture, system functions and prescription review rules setting of the Internet medical intelligent auxiliary prescription review system at present, which cannot meet the rapidly developing needs of Internet medical care. Using the construction experience of the prescription review system in medical institutions as a reference, this expert consensus makes recommendations on the construction and application of the Internet medical intelligent auxiliary prescription review system based on the functions and methods of formulating prescription review rules of the existing prescription review system, to further promote the standardization of the Internet medical prescription review work and ensure rational drug use.

Ulinastatin is mainly applied in the treatment of acute pancreatitis, but also in other common clinical critical illnesses such as shock, sepsis, evere pneumonia, cute respiratory distress syndrome, several acute poisoning, severe heat stroke, severe burns, severe trauma, and patients with sudden cardiac arrest for its roles in proteolytic enzymes inhibition and inflammatory responses regulation, which has been recommended by several guidelines/expert consensus on the diagnose and treatment of common clinical critical illness. However, there is currently a lack of consensus on the rational use of ulinastatin in terms of indications, usage, dosage, and others. Therefore, in order to promote the standardized application of ulinastatin, the expert group of expert consensus on the application of ulinastatin in common clinical critical illness summarized the mechanism, pharmacokinetics, indications of ulinastatin and its application methods in the treatment of common clinical critical illness, in order to provide a reference for the rational application of ulinastatin in clinical practice.

Menopause-related insomnia is a common symptom of perimenopausal women, which is clinically common but easy to be neglected. Menopause-related insomnia will affect the health of perimenopausal women and even in the old age. There is still a lack of consensus and guidelines on the clinical management of menopause-related insomnia in China. In order to standardize the management of menopause-related insomnia and improve the management of menopause-related sleep health, experts were organized to develop this consensus. The management of menopause-related insomnia mainly includes the establishment of a multidisciplinary expert team, pharmacological and nonpharmacological management, which is expected to play a guiding role in the clinical practice.

The prevention and delay of disability is important for promoting healthy aging. Exercise intervention is an efficient strategy for disability prevention. Besides, exercise intervention presents significant therapeutic advantages and broad application prospects due to low cost, low implementation difficulty, high acceptance and wide application scenarios. Therefore, Nursing Group of Chinese Society of Geriatrics, Committee on Geriatric Nursing of Chinese Association of Geriatric Research, China Gerontological Nursing Alliance, National Center of Gerontology, Institute of Geriatric Medicine of Chinese Academy of Medical Sciences jointly developed and published Clinical Practice Guidelines for Exercise Interventions for the Prevention of Disability in Older Adults (2023). According to the methodologies specified in WHO Handbook for Guideline Development, the guidelines finally involve 32 recommendations and 18 clinical issues containing exercise principles, effectiveness and plans of different types of exercise, facilitators and barriers during exercise, aiming to provide a reference for the development and implementation of exercise programs for older adults at risk of disability and standardize clinical practice, thus promoting the gateway to improving physical function of the older adults, reducing the prevalence of disability, improving quality of life, contributing to healthy aging.

Adequate gestational weight gain (GWG) is critical for maternal and child health. The Institute of Medicine (IOM) standard has long been adopted in clinical practice to guide GWG in China. Since October 2022, China has officially promulgated and adopted the Standard of Recommendation for Weight Gain during Pregnancy Period (WS/T 801-2022) (herein after referred to as SRWGPP) to guide GWG.

To compare the distribution of GWG recommended by the SRWGPP and IOM used for Chinese singleton pregnant women and associated adverse pregnancy outcomes, providing clinical evidence for further application of the SRWGPP.

The data of this study were from a prospective cohort study involving singleton pregnant women who gave birth in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from May 2020 to September 2021 and participated in the Beijing Birth Cohort Study (registration number: ChiCTR220058395) . Baseline information was collected from the participants, and the incidence of pregnancy complications and outcomes was obtained from the clinical health record system. We compared the distribution of GWG of the participants based on the criteria by the SRWGPP and the IOM guidelines. Then we divided the participants into five groups: insufficient weight gain (IOM+IW) , insufficient weight gain+appropriate weight gain (IOM+IW+AW) , appropriate weight gain (IOM+AW) , appropriate weight gain+ excessive weight gain (IOM+AW+EW) , and excessive weight gain (IOM+EW) . The risk of adverse pregnancy outcomes〔large for gestational age (LGA) , small for gestational age (SGA) , macrosomia, low birth weight, and preterm birth〕 was analyzed after adjusting for confounding factors.

A total of 11 839 singleton pregnant women were included. The proportions of women with insufficient, appropriate, and excessive GWG were 36.7% (4 339/11 839) , 38.9% (4 601/11 839) , and 24.5% (2 899/11 839) , respectively, according to the IOM standard, and were 16.2% (1 913/11 839) , 45.0% (5 332/11 839) , and 38.8% (4 594/11 839) , respectively, according to the SRWGPP. The proportions of pregnant women in groups of IOM+IW, IOM+IW+AW, IOM+AW, IOM+AW+EW and IOM+EW were 16.2% (1 913/11 839) , 20.5% (2 426/11 839) , 24.6% (2 907/11 839) , 14.3% (1 694/11 839) and 24.5% (2 899/11 839) , respectively. The results from multivariate Logistic regression analysis showed that the risk of overall adverse pregnancy outcomes in IOM+AW+EW group was higher than that in IOM+AW group〔aOR=1.23, 95%CI (1.07, 1.41) , P<0.05〕. There was no difference in the risk of overall adverse pregnancy outcomes between IOM+IW+AW group and IOM+AW group〔aOR=1.02, 95%CI (0.89, 1.16) , P<0.05〕. The risk of LGA, macrosomia, cesarean section, or the overall adverse pregnancy outcomes was higher in IOM+EW group than that in IOM+AW group either in the first or second trimesters (P<0.05) .

The adoption of the SRWGPP will allow more pregnant women to meet the appropriate range for GWG, and their pregnancy outcomes will be better than those using the IOM standard. Therefore, the SRWGPP is more applicable to Chinese pregnant women for pregnancy weight management. Especially, it is critical to avoid excessive GWG in the first and second trimesters.

Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.

It has been a consensus that cardiac rehabilitation is an effective comprehensive intervention for patients with coronary heart disease (CHD), but the quality of relevant guidelines is still unclear, and recommendations from the guidelines need to be integrated.

To systematically review the guidelines on cardiac rehabilitation in patients with CHD, providing evidence to inform clinical practice.

In June 2022, guidelines on cardiac rehabilitation in patients with CHD were searched in electronic databases of the Cochrane Library, Web of Science, PubMed, CNKI, CQVIP and Wanfang Data, relevant guideline repositories and association websites from inception to 30 June 2022. Literature screening and data extraction were performed by two researchers separately according to the inclusion and exclusion criteria. The quality of included guidelines was assessed using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ), and recommendations from which were summarized.

Ten guidelines (eight of them are foreign guidelines) with publication time ranging from 2011 to 2020 were eventually included. The average score of every AGREEⅡ domain was 71% for scope and purpose, 65% for stakeholder involvement, 58% for rigor of development, 80% for clarity of presentation, 64% for applicability, and 45% for editorial independence. Four guidelines were rated as grade A and the remaining six as grade B. Six aspects are involved in recommendations, including basic requirements of cardiac rehabilitation, heath education, risk factors control, psychological support, exercise training, and improvement of cardiac rehabilitation participation.

The quality of included guidelines is at a moderate to high level. More efforts are needed to improve the domains in stakeholder involvement, rigor of development, applicability, and editorial independence. Recommendations of the 10 guidelines tend to be consistent, but there are still insufficient recommendations on improving cardiac rehabilitation participation. There is a gap in the quality between domestic and foreign guidelines, so it is necessary to develop a high-quality guideline on cardiac rehabilitation for patients with CHD in China.

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.

Non-alcoholic fatty liver disease (NAFLD) is a common disease of the digestive system. With the improvements of living standards and breakthroughs in viral hepatitis research, NAFLD has replaced viral hepatitis as the most common chronic liver disease. Guidance documents can provide clinical staff with standard and reliable diagnosis and treatment approaches. The screening and development of high-quality guidance documents is of great importance to standardise the clinical practice of NAFLD.

To analyze the methodological quality and reporting quality of guidance documents for NAFLD, summarize and compare the recommendations, so as to provide a reference for the development and report of future guidelines for NAFLD.

PubMed, CNKI, CBM, Wanfang Data Knowledge Service Platform, VIP Database were searched for clinical guidelines and consensuses on NAFLD supplemented by WHO, GIN, NICE, SIGN and Medlive from 2012-01-01 to 2022-01-01. Two researchers in the field of liver disease screened the literature, extracted the data and independently evaluated the methodological quality and reporting quality of the included guideline documents using AGREE Ⅱ and RIGHT, respectively. The recommendations of the higher quality guideline documents were collated and compared by the two researchers.

A total of 19 publications were enrolled, including 12 guidelines and 7 consensuses; 6 in Chinese and 13 in English; 10 of which were developed using an evidence-based approach. The average scores for each domain of AGREE Ⅱ were 42.84% for scope and purpose, 31.43% for participants, 31.25% for rigour, 60.67% for clarity, 32.68% for application and 37.50% for independence. The average scores of RIGHT in each area were 59.65% for basic information, 66.12% for background, 42.11% for evidence, 39.85% for recommendations, 17.11% for review and quality assurance, 18.42% for funding and conflict of interest statement and management, 47.37% for other aspects. The average scores in AGREEⅡ and reporting qualities in RIGHT of evidence-based guidance documents were both higher than non-evidence-based guidance documents. The average scores in AGREEⅡ and reporting qualities in RIGHT of foreign guidance documents were higher than domestic guidance documents. The main recommendations relate to screening and diagnosis, assessment, management (non-pharmacologic and pharmacologic treatment) and surgical treatment.

The methodological quality and reporting quality of the published guidance documents for NAFLD still need to be improved, and there are still gaps between domestic guidance documents and international guidance documents. The development of TCM guidance documents should follow an evidence-based approach. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the development and reporting of guidelines. Clinical screening awareness for high-risk population of NAFLD and a comprehensive system for early non-invasive diagnosis and assessment should be established. Multidimensional treatment plans for lifestyle, liver function and metabolic disorders should be provided for patients with NAFLD.

Cancer cachexia is a cancer-related, multi-factorial, irreversible clinical syndrome characterized by progressive nutritional consumption, which greatly reduces the survival expectation and quality of life of cancer patient. In 2010, the European Palliative Care Research Collaborative published the Clinical Practice Guideline on Cancer Cachexia in Advanced Cancer Patients, which based on clinical evidence, providing recommendations about cachexia classification and treatment in patients with advanced cancer. However, the guideline is mainly applicable to patients with advanced cancer who may present with refractory cachexia. Based on the continuously updated evidence, the European Society of Medical Oncology released the Cancer Cachexia in Adult Patients: ESMO Clinical Practice Guideline, which provides a more clear structural framework for the management of cancer cachexia, focusing on all cancer patient who may develop into cachexia, making recommendations in terms of screening, evaluation and multimodal management of cachexia. This paper interprets and summarizes the key points of the guideline in order to provide a reference for clinical management of cancer cachexia in China.