Clinical Practice Guideline on Acupuncture and Moxibustion:Adult Major Depressive Disorder(Mild-Moderate Degree):Determination of clinical questions

Determining clinical questions is fundamental to the development of clinical practice guidelines(CPGs),which bridges the initial phases and the final recommendations.It is essential for evidence retrieval and the formulation of recommendations.The scientific rigor and precision in determination of clinical questions directly influence the future implementation and applicability of guidelines.In 2020,the World Federation of Acupuncture-Moxibustion Societies initiated the project of clinical practice guideline on acupuncture and moxibustion for adult major depressive disorder(mild-moderate degree)to address clinical and medical decision-making issues in acupuncture treatment for adult mild to moderate major depressive disorder.This CPG provides systematic recommendations based on clinical evidence,patient values,and other factors,aiding decision-makers,clinicians,and patients in selecting appropriate interventions.This paper discusses and analyzes the determination process of clinical questions,and the related issues during the development of this guideline,aiming to provide a reference for determining clinical questions and developing CPGs in the field of acupuncture and exploring more scientific tools and methods for determining clinical questions in future CPGs.

Differences in Contents and Formation Methods of Clinical Questions in Chinese and Korean Clinical Practice Guidelines of Acupuncture-Moxibustion:Scoping Review

Objective:To analyze the differences in the needs of users and the value orientation of clinical practice guidelines(CPGs)by comparing the contents and formation methods of clinical questions in Chinese and Korean CPGs of acupuncture-moxibustion(Acup-Mox).Methods:The full text of CPGs was systematically searched from the official websites of Chinese and Korean traditional medicine societies and Acup-Mox associations,with the topic"Acup-Mox for treating diseases"and the retrieval time up to September 28,2022.Two researchers screened the CPGs independently,and extracted the guidelines'topics,content,quantity and formation methods of clinical questions.The quantitative data were collected by counting the frequency,and the qualitative data were classified and described by thematic analysis.Results:A total of 29 guidelines were included in this study,including 20 Chinese guidelines(305 questions)and 9 Korean guidelines(223 questions).The differences lie in the aspects of content and diversity,and formation method.As for content and diversity,Chinese guidelines focused mainly on the questions related to treatment such as the operation of specific intervention(86,28.2%),efficacy of intervention(78,25.6%),and also involving questions in diagnosis,prevention,and prognosis.While the clinical questions in Korean guidelines were concentrated to efficacy of intervention(218,97.8%).As for formation method,in Chinese guidelines,questions were usually collected directly from clinicians,and then determined and optimized by experts.In Korean guidelines,frequently used clinical Acup-Mox interventions would be screened first.Then the expert group would set up corresponding intervention control measures so as to form clinical questions related to treatment efficacy.Conclusions:The differences reflect the different needs of clinical practitioners,and the different aims or concepts in developing Acup-Mox guidelines between China and South Korea.Chinese guidelines emphasized promoting operation protocols and techniques of Acup-Mox for practical use,while Korean guidelines emphasized promoting the frequently used clinical intervention therapies.It is speculated that the guidelines from these two countries would play different roles in guiding clinical operation and supporting medical decision.In terms of formation methods of clinical questions,it is suggested to attach importance to optimizing process in formatting clinical questions to improve the clinical applicability of CPGs of Acup-Mox.

The most important questions in cancer research and clinical oncology Question 2-5.Obesity-related cancers:more questions than answers

Obesity is recognized as the second highest risk factor for cancer. The pathogenic mechanisms underlying tobaccorelated cancers are well characterized and efective programs have led to a decline in smoking and related cancers, but there is a global epidemic of obesity without a clear understanding of how obesity causes cancer. Obesity is heterogeneous, and approximately 25% of obese individuals remain healthy(metabolically healthy obese, MHO), so which fat deposition(subcutaneous versus visceral, adipose versus ectopic) is "malignant"? What is the mechanism of carcinogenesis? Is it by metabolic dysregulation or chronic inflammation? Through which chemokines/genes/signaling pathways does adipose tissue influence carcinogenesis? Can selective inhibition of these pathways uncouple obesity from cancers? Do all obesity related cancers(ORCs) share a molecular signature? Are there common(overlapping) genetic loci that make individuals susceptible to obesity, metabolic syndrome, and cancers? Can we identify precursor lesions of ORCs and will early intervention of high risk individuals alter the natural history? It appears unlikely that the obesity epidemic will be controlled anytime soon; answers to these questions will help to reduce the adverse efect of obesity on human condition.

The most important questions in cancer research and clinical oncology

Specific research foci:(1) Mouse models of gamma-herpes virus-68(γHV-68) and polyomavirus(Py V) infections during neonatal versus adult life.(2) For human papilloma virus(HPV)-positive oropharyngeal carcinoma(OPC)—(a) Asking the question: Is oral sex a powerful carcinogen?(b) Examining the evidence for the vertical transmission of HPV infection.(c) Examining the relationship between HPV and Epstein–Barr virus(EBV) infections and nasopharyngeal cancer(NPC) in West European, East European, and East Asian countries.(d) Examining the association between HPVpositive OPC and human leukocyte antigen(HLA).(3) For non-smoking East Asian female lung adenocarcinoma—(a) Examining the incidence trends of HPV-positive OPC and female lung adenocarcinoma according to birth cohorts.(b) Examining the association between female lung adenocarcinoma and HPV.(c) Examining the associations of lung adenocarcinoma with immune modulating factors.(4) For triple-negative breast carcinoma(TNBC) in East Asians—(a) Examining the association between TNBC and HPV.(b) Examining the unique epidemiological characteristics of patients with TNBC. A summary "epidemiological" model tying some of these findings together.

World Federation of Acupuncture-Moxibustion Societies(WFAS)Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis recommendation summaries

Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for allergic rhinitis approved by an international academic organization,which provides evidence-based recommendations and the practical therapeutic protocols for acupuncture practitioners globally.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the principles of the World Health Organization Handbook for Guideline Development.The members in the guideline development group(GDG)were from different countries,with different professions,and they played a critical role in the development of clinical questions,recommendations,and therapeutic protocols.Recommendations are the core of a CPG and the direct answers to clinical questions,due to which this article focuses on the recommendations of this CPG.The recommendations were developed by using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of 15 recommendations for 15 clinical questions were developed in this CPG,including one strong recommendation for intervention based on high-quality evidence,three conditional recommendations for either the intervention or the comparison based on very low quality of evidence,and 11 conditional recommendations for the intervention based on very low quality of evidence.

World Federation of Acupuncture-Moxibustion Societies(WFAS)Clinical Practice Guidelines on Acupuncture and Moxibustion:Female Urinary Incontinence recommendation summaries

Urinary incontinence(UI)is common in women and affects the quality of life in female patients severely.But the clinical consideration and treatment are insufficient.Acupuncture and-moxibustion has been proposed as a potentially effective intervention for female UI.Hence,the World Federation of Acupuncturemoxibustion Societies(WFAS)have initiated a project to develop the clinical practice guideline(CPG)on acupuncture and moxibustion for female UI towards global acupuncture practitioners.The CPG was developed according to the Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,referring to the principles of the World Health Organization Handbook for Guideline Development.During the development of the CPG,the guideline development group(GDG)played an important role,which is composed of multi-national and multi-disciplinary experts.The clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method and basing on the results of the latest systematic review.This article focuses on the recommendations in the CPG.The CPG contains ten recommendations for ten clinical questions,including nine conditional recommendations for the intervention,one conditional recommendations for either the intervention or the comparison.The CPG also provides one conventional filiform needle therapy protocol,two deep puncturing stimulation on lumbosacral acupoints therapy protocols,and four moxibustion therapy protocols,extracted from the included clinical evidence of this CPG.

Key questions and outcomes for the clinical practice guideline on acupuncture and moxibustion for allergic rhinitis

Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis(AR).Methods:PICO(patient,intervention,comparator,and outcome)question survey,Delphi survey,and consensus conference of the guideline development group(GDG)were employed.PICO questionnaires were used to gather and analyze the target users’key demands and interests.The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference.Results:Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents.After two rounds of the Delphi survey and complete discussions,a consensus was reached by the GDG that all potential questions were included.After three rounds of the Delphi survey and complete debate,the consensus was reached that nine outcomes were considered important.Conclusion:Fifteen key clinical questions and nine important outcomes were formulated for the CPG.These covered issues elicited the most attention from global users in acupuncture therapy and AR.The results will contribute to the CPGs development and future clinical studies.

Clinical question survey for the clinical practice guideline on acupuncture and moxibustion for urinary incontinence in women

The survey aims to collect clinical questions for the clinical practice guideline on acupuncture and moxibustion in treating urinary incontinence in women.The survey is consisted of multiple-choice questions,ranking questions and open questions.We hope you can help us to complete the questions using PICO(Patients,Intervention,Comparator and Outcome)framework referring to the examples.The survey might take about 30 min,and the responses from you will greatly contribute to the formation of this guideline.

Clinical question survey for the clinical practice guideline on acupuncture and moxibustion for allergic rhinitis

The survey aims to collect clinical questions for the clinical practice guideline on acupuncture and moxibustion in treating allergic rhinitis.The survey is consisted of multiple-choice questions,ranking questions,and open questions.Readers are recommended to complete the open questions using PICO(Patients,Intervention,Comparator and Outcome)framework,referring to the examples.The survey might take about 30 min,and the responses from readers will greatly contribute to the formation of this guideline.