Special Issue:guidebook/guide Interpretation
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.
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.
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.
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.
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.
Asthma is a serious health problem affecting people of all ages worldwide. To address asthma, the Global Initiative for Asthma Expert Group published the Global Strategy for Asthma Management and Prevention in 1995, and an updated version (GINA 2022) with new evidence being incorporated, on the World Asthma Day, May 3, 2022. Asthma prevalence is increasing but is unsatisfactorily controlled generally in China. We mainly interpreted the update points in the GINA 2022, discussed the management of asthma during the COVID-19 pandemic, and assessed the significance of the GINA 2022 for the diagnosis and treatment of asthma in China.
The American Heart Association (AHA) , American College of Cardiology (ACC) and Heart Failure Society of America (HFSA) jointly released the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure (hereinafter referred to as the 2022 Guideline) . In the light of the latest evidence, the essentials updated in the 2022 Guideline encompass the prevention, stages, classification, drug treatment and device-based treatment of heart failure. The 2022 Guideline is content-enriched, evidence-based, practical, and easily operable, which may greatly contribute to clinical practice in China. In response to the most concerns of clinicians, we overviewed and discussed the updates in stages, classification and drug treatment of heart failure in the new guideline.
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.
As China enters a deep aging society, falls and fall-related injuries in older adults have gained increased attention, with increasing emergence of relevant studies, and continuous updates in relevant guidelines. In 2022, The World Falls Task Force assembled 96 experts from 39 countries to develop the World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative. The guidelines were developed using the person-centered methodology and the latest evidence on e-health for the prevention of falls, with full consideration of the needs of fall management of older adults, and their caregivers and other stakeholders' perspectives on preventing falls in older adults, as well as the guideline applicability in various care settings and locations with limited resources, which provide new clinical recommendations on the screening, assessment, and management of risk for falls among community-dwelling older adults. This paper offers an in-depth interpretation of the guidelines and an analysis of the effective practical guidance in the guidelines, providing practical guidance for Chinese physicians, nurses and community health workers to prevent and manage falls in older adults.
Sleep disorders, especially insomnia and sleep behavior disorders, are highly prevalent in children with autism spectrum disorder (ASD) , which cause a wide range of detrimental effects on the children and their families. Several international professional organizations have highlighted integrating sleep disorders into the comprehensive evaluation and treatment in children with ASD, and developed relevant clinical guidelines or expert consensuses, such as the A Practice Pathway for the Identification, Evaluation, and Management of Insomnia in Children and Adolescents with Autism Spectrum Disorders by the Autism Treatment Network (ATN) , Autism: the Management and Support of Children and Young People on the Autism Spectrum by the National Institute for Health and care Excellence (NICE) , and Practice Guideline: Treatment for Insomnia and Disrupted Sleep Behavior in Children and Adolescents with Autism Spectrum Disorder by the American Academy of Neurology (AAN) . However, there is no applicable clinical guideline or expert consensus for sleep disorders among Chinese children with ASD, which greatly restricts the development of relevant clinical practice. We interpreted the above-mentioned two guidelines and one consensus, focusing mainly on several aspects, such as the levels of evidence and strength of recommendations, the definition of sleep disorders and associated factors, and behavioral treatments and melatonin-based therapies. It is hoped that our endeavors will contribute to the diagnosis and management of sleep disorders in Chinese children with ASD and the development of relevant clinical guidelines or expert consensuses.
Persistent genital arousal disorder (PGAD) and genito-pelvic dysesthesia (GPD) are jointly known as PGAD/GPD, which is a newly discovered condition in recent years, featured by spontaneous or secondary persistent genital arousal and/or dysesthesia in the genital and pelvic areas. PGAD/GPD mainly affects women, which can seriously influence the physical and mental health of the sufferers due to the specificity of its symptoms. Most patients have anxiety, depression, and even the suicidal tendency. The medical community abroad has paid attention to PGAD/GPD, and included it in the International Classification of Diseases-11th Revision (ICD-11) . Given the fact that this newly discovered condition is under-recognized among domestic health providers at present, we summarized the current research on PGAD/GPD abroad and introduced the epidemiological characteristics, pathophysiological mechanisms, diagnosis and treatment methods of PGAD/GPD based on the review of the latest expert consensus of the International Society for the Study of Women's Sexual Health (ISSWSH) , and discussed the future research direction of PGAD/GPD and the coping strategies that should be taken by the domestic medical community, with a view to arousing medical workers' attention to the disease in China.
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.
Chronic obstructive pulmonary disease (COPD) is a common, chronic heterogeneous airway disease. Although recent years have witnessed growing advances in both COPD research and management, there are still many difficulties need to be solved urgently. In view of this, the Lancet published Towards the Elimination of Chronic Obstructive Pulmonary Disease in September 2022, a document in which new ideas on the recognition, diagnosis, assessment and individualized treatment of COPD and relevant clinical guidance were proposed. This article focuses on the introduction and interpretation of the classification, diagnostic criteria and diagnostic recommendations of COPD in this document, the acute exacerbation of COPD and the move towards elimination of COPD, hoping to provide insights into COPD research and management conducted by Chinese clinical workers.
Current Status and Challenges of Cervical Cancer Treatment：from Clinical Guidelines to Real-world Study
Cervical cancer is a type of malignancy that severely threatens women's health. For invasive cervical cancer, standardized preoperative staging and assessment are essential before the start of treatment. With regard toearly cervical cancer, surgery is the major treatment, with considerations for the latest updates in relevant guidelines, and the determination of extent of resection as well as the selection of proper surgical approach. For advanced or relapsed cervical cancer, radiotherapy and chemotherapy are the main treatments. However, there are many challenges and controversies regarding the treatment and clinical research of cervical cancer. We mainly discussed the present status and challenges of cervical cancer diagnosis and treatment based on clinical guidelines and practices, aiming at bettering the real-world practice with the support of clinical guidelines.
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.
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.
Today's world, there is an increasing number of people drinking alcoholic beverages. Drinking alcohol can induce several diseases and is a serious threat to human health, but whether it has a positive effect on the cardiovascular system is controversial. Traditional beliefs have suggested that small to moderate amounts of alcohol consumption (female intake of ≤ 1 standard amounts of alcoholic beverages daily, male intake of ≤ 2 standard amounts of alcoholic beverages daily, 1 standard amounts of alcoholic beverages=12-15 g pure ethanol) might be beneficial for the treatment of cardiovascular diseases (such as atherosclerotic cardiovascular disease) , whereas heavy drinking (intake of > 2 standard amounts of alcoholic beverages daily) leads to impairment of the cardiovascular system, the bidirectional effect of a "J" - shaped curve. In recent years, there has been a growing debate on whether traditional ideas are correct, involving many aspects such as the pattern of drinking, the type of alcoholic beverage and the different types of CVD that they affect. This article discusses the consensus and disagreement in the debate on bidirectional effects of drinking on cardiovascular system by pooling and analyzing recent results from relevant studies at home and abroad, finding that although there is no consistent view in the current relevant studies, most research results suggest that small to moderate alcohol consumption may benefit cardiovascular health, especially in middle-aged and elderly people with pre-existing atherosclerosis and cardiovascular disease. It may provide ideas for developing lifestyle intervention guidelines for cardiovascular disease prevention and control in the future.
People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. The American Diabetes Association (ADA) and the Kidney Disease: Improving Global Outcomes (KDIGO) established joint group, and integration of evidence-based recommendations for diabetes management in patients with CKD in accordance with the ADA 2022 standards of medical care in diabetes and KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD, and to form the Diabetes Management in Chronic Kidney Disease: a Consensus Report by the ADA and KDIGO. The consensus not only re-emphasizes the published guidelines for screening and diagnosis of CKD, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management, but also specifically emphasizes the importance of comprehensive care in which pharmacotherapy based on a foundation of healthy lifestyle. The consensus states seven core recommendations which provide specific guidance for the use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineral corticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD. Focusing on the main contents of the consensus, we interpreted main recommendations in order to provide concise and practical guidance for clinicians, to achieve the goal of improving the prognosis of patients with diabetes mellitus complicated with CKD.
The clinical and translational research of pulmonary hypertension (PH) has been continuously deepened, which has promoted the updating of PH related guidelines. On August 26, 2022, the European Society of Cardiology (ESC) and the Respiratory Society (ERS) jointly released the 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension (hereinafter referred to as the "2022 ESC/ERS Guidelines") . In January 2021, Chinese Thoracic Society and Chinese Association of Chest Physicians jointly released the Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension (2021 Edition) (hereinafter referred to as the "Chinese Guidelines") , in which a lot of recommendations were put forward in line with China's national conditions combining with the research at home and abroad at that time. This paper will focus on the interpretation of the update points of the ESC/ERS Guidelines in combination with the relevant contents of the Chinese Guidelines.
The guidelines on physical activities in individuals with type 2 diabetes, a common chronic metabolic disease, have been updated continuously, and relevant recommendations from them are increasingly improved, but there are still difficulties in these people's daily activities need to be addressed. In February 2022, the American College of Sports Medicine and the American Diabetes Association issued the Exercise/Physical Activity in Individuals with Type 2 Diabetes (EPAIT2D) by updating the Exercise and Type 2 Diabetes, a statement jointly published by them in 2010, which provides a concise summary of new clinical recommendations on age-specific physical activity, optimal timing of activities, effectiveness of medical intervention and physical activity, and precautions regarding physical activities and diets in type 2 diabetics. We interpreted the essentials and key updated contents of the EPAIT2D, and put forward recommendations on clinical delivery of exercise/physical activity interventions targeting Chinese type 2 diabetics.
Summary of the Essentials for the Diagnosis and Treatment of Sexually Transmitted Proctitis，Proctocolitis and Enteritis from CDC's Sexually Transmitted Infections Treatment Guidelines，2021
Sexually transmitted infections (STIs) may cause symptomatic proctitis, proctocolitis and enteritis. Given that there are still many questions in the management of proctitis, proctocolitis and enteritis caused by STIs. On July 23, 2021, CDC released the latest guidelines on the diagnosis and treatment of STIs. Combining the latest literature and clinical experience, we focused on the interpretation of the differences between the new version and the previous version. We also compared part of the 2021 European Guideline on the Management of Proctitis, Proctocolitis and Enteritis Caused by Sexually Transmissible Pathogens with the essentials for the management of sexually transmitted proctitis, proctocolitis and enteritis in the CDC's Sexually Transmitted Infections Treatment Guidelines, 2021, aiming to assist clinicians in the management of proctitis, proctocolitis and enteritis caused by STIs.
Cushing disease, the most common cause of endogenous Cushing's syndrome characterized by hypercortisolemia, is a clinical syndrome caused by adrenocorticotropic hormone (ACTH) ——secreting pituitary adenomas. The excessive secretion of ACTH in Cushing's disease stimulates bilateral adrenal hyperplasia and causes hypercortisolemia, which can lead to a series of severe clinical syndromes such as electrolyte imbalance, glucose and lipid metabolism disorders, involving multiple organs and systems in the body. The clinical symptoms of Cushing's disease are complex and diverse, and its diagnosis and treatment are extremely challenging. In December 2021, the International Pituitary Society released the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update, which focuses on the complications and comorbidities of Cushing's disease, such as hypercoagulability, cardiovascular disease, metabolic bone disease, growth hormone deficiency and infection, etc.; discusses the application of the latest evidence in clinical practice, with a particular focus on new treatment and screening options, diagnostic algorithms, and best practices for preventing disease recurrence. Based on the latest evidence-based medical evidence, this article focuses on the interpretation of Cushing's disease——related laboratory examinations, imaging examinations, diagnosis and treatment management procedures, and recurrence monitoring discussed in the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update, in order to improve the general practitioners and specialists'understanding of this syndrome and improve the prognosis of patients with Cushing's disease.
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.
Ultrasound-based Thyroid Nodule Malignancy Risk Stratification in Differentiating Benign and Malignant Thyroid Nodules：a Comparative Analysis between the C-TIRADS and ATA Guidelines
The 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS (C-TIRADS for short) put forward a method for stratifying the malignancy risk of thyroid nodules, but there are few studies about its value in differentiating benign and malignant thyroid nodules.
To compare the value of ultrasound-based thyroid nodule malignancy risk stratification in differentiating malignant and benign thyroid nodule between C-TIRADS and 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer (ATA guidelines for short) .
A total of 336 inpatients who underwent surgery and ultrasound examination in Bozhou People's Hospital from January 2019 to May 2021 were selected as participants. Four ultrasonologists with a title higher than attending physician were equally randomized into groups A and B for evaluating ultrasonic examination results according to ultrasound-based thyroid nodule malignancy risk stratification in C-TIRADS and ATA guidelines, respectively. The accuracies of ultrasound-based thyroid nodule malignancy stratification in the two guidelines in differentiating malignant and benign thyroid nodules were assessed using intraoperative or postoperative pathological findings (gold standard for diagnosis) , and were further analyzed using ROC analysis.
According to intraoperative or postoperative pathological findings, the participants had 367 thyroid nodules in total, including 253 benign nodules and 114 malignant nodules. The nodules were classified as follows according to the TI-RADS in the C-TIRADS by ultrasonologists in group A: (1) 253 benign nodules: 2 were in TI-RADS 5 category, 23, 30, and 80 were in categories 4c, 4b, and 4a, respectively, 103 were in 3 category, and 15 were in 2 category; (2) 114 malignant nodules: 24 were in TI-RADS 5 category, 59 were in 4c category, 22 were in 4b category, 6 were in 4a category and 3 were in 3 category. And the classification of nodules according to the ATA guideline by ultrasonologists in group B was: (1) 253 benign nodules: 13, 53, 47, 118 were high, intermediate, low, and very low suspicion pattern for malignancy, respectively, and 22 were benign pattern; (2) 114 malignant nodules: 76, 24, 8, 6 were high, intermediate, low, and very low suspicion pattern for malignancy, respectively. ROC analysis showed that, AUCs of ultrasound-based thyroid nodule malignancy risk stratification in differentiating malignant and benign thyroid nodules between C-TIRADS and ATA guidelines were 0.890〔95%CI (0.815, 0.918) 〕and 0.780〔95%CI (0.750, 0.876) 〕, with significant difference (Z=13.62, P<0.05) . The TI-RADS in the C-TIRADS showed 92.11% sensitivity, 78.26% specificity, 82.56% accuracy, with Youden index of 0.70 in differentiating 4b category benign and malignant nodules, and demonstrated 97.37% sensitivity, 46.64% specificity, 62.40% accuracy with Youden index of 0.44 in differentiating 4a category benign and malignant nodules. The ultrasound-based thyroid nodule malignancy risk stratification in ATA guideline showed 87.72% sensitivity, 67.98% specificity, 74.11% accuracy, with Youden index of 0.56 in differentiating intermediate suspicion pattern for malignancy, and demonstrated 94.74% sensitivity, 44.66% specificity, 60.22% accuracy with Youden index of 0.39 in differentiating low suspicion pattern for malignancy.
The ultrasound-based thyroid nodule malignancy risk stratification in C-TIRADS has higher value in differentiating malignant and benign thyroid nodules than that in ATA guidelines, and the optimal performance of which may be manifested in differentiating malignant and benign thyroid nodules of TI-RADS 4b category.
Local wound management is a key part in the management of diabetic foot ulcers (DFUs), and dressings are one major tool. There are no specific guidelines on dressing selection for DFUs, and it is urgently needed to integrate relevant contents scattered in major comprehensive guidelines.
Practice guidelines related to the management of diabetic foot were searched and reviewed, and entries related to dressing selection or application were extracted for evidence synthesis to inform clinical interventions.
Published clinical practice guidelines about diabetes management were searched from diabetes websites and electronic literature databases, the search period was from January 2012 to November 2021, and screened according to inclusion and exclusion criteria, then their methodological quality was evaluated, and evidence related to dressing selection and application in which was translated, extracted and synthesized.
Ten guidelines published between 2012 and 2020 were included, with overall high quality and high consistency between reviewers. Then a table of recommendations for selection and application of wound dressings for diabetic foot disease was developed by comprehensively summarizing relevant evidence extracted from the guidelines (evidence from eight guidelines in foreign languages was first translated into Chinese before being extracted) .
The evidence selected from the guidelines involves wound characteristics, moisture healing, periwound skin management, patient preference, and cost. Among them, wound characteristics should be seriously considered in the selection of dressings for DFUs. Most of the recommendations are about the treatment of wound exudate condition and the presence or absence of infection. However, there are fewer recommendations for basal tissue types, especially gangrene wounds.
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.
Evidence-based clinical guidelines are important resources for promoting the provision of high-quality and effective general practice services. Research on the development, application and effectiveness evaluation of guidelines in general practice is insufficient.
To understand the development and application of international guidelines in general practice, informing the development and utilization of relevant guidelines in China.
The PubMed database was systematically searched from August to September 2022 for studies in English related to the development, application and effectiveness of guidelines in general practice published during January 1, 2012 to September 7, 2022. The author information and focused issues as well as publication journals of the studies were extracted. And associated factors of the development, distribution and use, and effectiveness of guidelines were reviewed.
(1) A number of countries, including China, conducted the research using quantitative, qualitative, literature review and theoretical methods. (2) Organisations of general practitioners (GPs) and researchers in general practice leading or participating in guideline development, can improve the guideline acceptability and applicability, and the integration of physician experiences and patient preferences in shaping the guideline. General practice consensus is an appropriate type of the guideline. Referral recommendation is one key component of the guidelines. Guideline analysis and adaptation can be used as a strategy for GPs training. (3) Compared with specialty guidelines, the application of guidelines in general practice has been affected by more factors. Problem-oriented and self-guided guideline trainings are beneficial to the improvement of guideline compliance. Clinical audits and evidence-based medicine journal clubs are common and effective approaches for promoting guideline implementation. GPs' feedback on the guideline contributes to continuous improvement of the guidelines. (4) The impact of these guidelines on GPs' practice behaviour can be assessed observationally, while that on patient outcomes requires to be assessed using more rigorous and complex study designs.
GPs' participation in the development, implementation and evaluation of the guidelines is an enviable trend of the development in evidence-based general practice. GPs' experience and humanism, patients' preferences and expectations, and various internal and external factors associated with general practice, all need to be incorporated into the development, implementation, and evaluation of the guidelines, under collaboration with methodological experts.
Cushing's disease, the most common cause of endogenous Cushing's syndrome, is hypercortisolemia caused by adrenocorticotropic hormone-secreting pituitary adenoma. Patients may present clinical symptoms such as moon face, buffalo back, central obesity and metabolic disorders due to the persistence of hypercortisolemia. Accurate diagnosis, appropriate treatment and follow-up of Cushing's disease are vitally important. Based on recent evidence, the Pituitary Society published the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update in December 2021, with updates in screening and diagnosis procedures, postoperative monitoring, medical therapies and radiotherapy, and complication management. This article interprets the medical therapies recommended in the consensus, which will be helpful for general practitioners and specialists to standardize the diagnosis and treatment of Cushing's disease.
Quality Assessment of Guidelines forVascular Cognitive Impairment Using the AGREEⅡ
As the second primary type of cognitive impairment worldwide, vascular cognitive impairment (VCI) is closely associated with cerebrovascular risks, which imposes a heavy burden on the society and families. Early diagnosis and treatment are important for intervening and reversing VCI. And formulating high-quality clinical guidelines is an effective way to improve diagnosis and treatment levels of VCI.
To assess the quality of guidelines for VCI, aiming at offering support for making clinical decisions for VCI.
From August to November 2021, we searched literature databases and websites in China and abroad to identify guidelines for VCI, and assessed them using the Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ.
A total of 18 guidelines were enrolled, 12 of which are Chinese guidelines and 6 are foreign guidelines; 9 of which are evidence-based guidelines, and the other 9 are not. The intraclass correlation coefficient was 0.935, indicating a high degree of agreement between raters. The overall quality of these guidelines was relatively low, since in the six domains, only the average score of Clarity of Presentation was greater than 60% (64.04%) , and the average scores of Scope and Purpose (52.31%) and Editorial Independence (42.01%) were between 30% and 60%, and those for other three domains, Stakeholder Involvement (27.24%) , Rigor of Development (20.05%) and Applicability (13.83%) , were all less than 30%. The grade of recommendation for 6 guidelines was B, and that for other 12 guidelines was C.
The overall quality of the included guidelines was rated relatively low, especially their average score for each of the three domains, Stakeholder Involvement, Rigor of Development, and Applicability, was below the average level. It is suggested to enhance the quality of VCI guidelines via improving the details of guidelines strictly under the evidence-based principle.
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.
Special Issue:guidebook/guide Interpretation
