Clinical practice guideline for acupuncture and moxibustion:Allergic rhinitis

Acupuncture is one of the most effective complementary therapies for allergic rhinitis(AR)and has been recommended by several clinical practice guidelines(CPGs)for AR.However,these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols,therefore limiting the applicability of acupuncture therapies for AR.Hence,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat AR.This CPG was developed according to the Grading of Recommendations 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.The clinical questions,recommendations and therapeutic protocols were all formulated by the GDG using the modified Delphi method.The CPG contains recommendations for 15 clinical questions about the use of acupuncture and moxibustion interventions.These include one strong recommendation for the intervention based on high-quality evidence,three conditional recommendations for either the intervention or standard care,and 11 conditional recommendations for the intervention based on very low quality of evidence.The CPG also provides one filiform needle acupuncture protocol and five moxibustion protocols extracted based on the protocols presented in randomized controlled trials reviewed by the GDG.

Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence

Urinary incontinence (UI) is a common problem worldwide.It has a major impact on physical and social activities and interpersonal relationships.UI is common in women,but is under-reported and undertreated.It affects the quality of life of female patients severely.Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI.Hence,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI.This CPG was developed according to the Grading of Recommendations 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.The clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method.This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions,which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison.This CPG also provides one protocol for conventional filiform needle therapy,two therapy protocols for deep needling stimulation on lumbosacral acupoints,and four moxibustion therapy protocols,based on the protocols presented in randomized controlled trials reviewed by the GDG.

World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guideline on Acupuncture-Moxibustion:Non-Specific Low Back Pain recommendation summaries

Clinical Practice Guideline on Acupuncture and Moxibustion:Nonspecific low back pain 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 nonspecific low back pain approved by an international academic organization,which provides the evidence-based recommendations and practical therapeutic protocols for international acupuncture practitioners.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 guideline development group(GDG)from different countries,with different professions,played a critical role in the formulation of clinical questions,recommendations,and therapeutic protocols.Recommendations are the key content of a CPG and the direct answers to clinical questions.Hence,this article focuses on the recommendations of this CPG.The recommendations were formulated using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of seven recommendations for ten clinical questions were formulated in this CPG,including one conditional recommendation for either the intervention or the comparison based on very low quality of evidence,and six conditional recommendations for the intervention based on very low quality of evidence.

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.

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.

China Association of Acupuncture–Moxibustion Evidence-based clinical practice guideline of acupuncture and moxibustion: Primary dysmenorrhea

Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.

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 practice guidelines of using acupuncture for low back pain

Based on extensive accumulated evidence and using the Grading of Recommendations Assessment, Development and Evaluation（GRADE） system, we have developed clinical practice guidelines for the use of acupuncture to treat low back pain（LBP）. In the guidelines, we considered the objective and scope of this guide, the diagnostic criteria and syndrome differentiation standards of traditional Chinese medicine and western medicine for LBP, the treatment principles of acupuncture, intervention opportunities for acupuncture, and recommendations for use of different acupuncture therapies for acute/subacute and chronic LBP.

Exploration of Stratified Evidence Scoring Method of Acupuncture Clinical Practice Guidelines

Due to its own internal laws of development,Chinese medicine(CM)seems more inclined to empirical medicine in a relatively long historical period.It is considered to be lacking objective and unified clinical practice guidelines(CPGs),and the difficulties in diagnosis and therapeutic effect evaluation comes with it,have restricted its further inheritance,development and international communication.Over the years,our research group has been committed to improving the standardization theory and methodology of CM,also perfecting relative techniques for further application,which are all based on the stratified evidence scoring method.We have already applied this method to 45 issued guidelines,including 5 national guidelines,3 industrial guidelines,and 37 formulation/revision social organization guidelines.The stratified evidence scoring method has been recognized and used widely.It helps scholars and applicators to study,formulate,publish and popularize the acupuncture therapy clinical practice guidelines better,thus further promotes the development of acupuncture therapy.

Recommendations for Acupuncture in Clinical Practice Guidelines of the National Guideline Clearinghouse

Objective： To organize the clinical practice guidelines（CPGs） related to acupuncture included in the National Guideline Clearinghouse（NGC） to systematically summarize the diseases and disorders most commonly treated with acupuncture, the strength of recommendations for acupuncture and the quality of evidence. Methods： The NGC database was systematically searched for guidelines that included acupuncture as an intervention. Two independent reviewers studied the summaries and the full texts of the guidelines and included guidelines based on the inclusion and exclusion criteria. Thirty-nine guidelines were collected with 80 recommendations. The Appraisal of Guidelines for Research and Evaluation（AGREE） Ⅱ instrument was used to assess the quality of these guidelines. Results： Of the 80 recommendations on acupuncture, 49 recommendations were clearly for acupuncture, 25 recommendations were against acupuncture and 6 recommendations did not indicate any clear recommendations, 37 recommendations were for painful diseases/disorders, and 12 recommendations were for non-painful diseases/disorders. Locomotor system disorders were the most common in the painful diseases/disorders category. Out of all the recommendations for acupuncture, most recommendations（87.76%） were weak in strength, and most of the evidence（40.84%） was of low quality. Conclusion： In the National Guideline Clearinghouse, the recommendations for acupuncture focus on painful diseases/disorders. The recommendations in the guidelines are not high in strength, and most of the evidence is moderate or low in quality.

Assessing the Quality of the First Batch of Evidence-Based Clinical Practice Guidelines in Traditional Chinese Medicine

Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.

Study on the Methodology of Developing Evidence-Based Clinical Practice Guidelines of Chinese Medicine

At present, evidence-based clinical practice guideline （EBCPG） is the main mode of developing clinical practice guidelines （CPGs） in the world, but in China, most of CPGs of Chinese medicine （CM） are still guidelines based on expert consensus. The objective of this study is to construct initially the methodology of developing EBCPGs of CM and to promote the development of standardization of CM. Based on the development of ＂Guideline for Diagnosis and Treatment of Common Pediatric Diseases in CM＂, the methodology of developing EBCPG of CM was explored by analyzing the pertinent literature and considering the characteristics of CM. In this study, the key problem was to put forward the suggestion and strategies. However, due to the methodology study of developing EBCPG of CM is still in the initial stage, there are still some problems which need further study.

Development of rapid advice guideline and standard and continuous updating guideline:experiences and practice

We published rapid advice guidelines and updated guidelines for coronavirus disease 2019(COVID-19)management on February 6,2020,and September 4,2020,respectively.These two guidelines vary widely in their developmental background,type of evidence,grade of recommendation and so on.We shared our experience for the development of these two guidelines to help clinical practitioners better understand and implement guidelines and to help guideline developers facilitate communication and discussion for guideline development during the pandemic.

Clinical Practice Guideline of Acupuncture for Bell's Palsy

Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy because ofthe poor quality and heterogeneity. It's urgently necessary to develop a guideline of acupuncture for Bell's palsy based on principles of evidence-based medicine to optimize acupuncture treating,standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell's palsy under general circumstances.Objective: To improve the accuracy of diagnosing and managing Bell's palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell's palsy, and to improve the quality of acupuncture for patients with Bell's palsy in most instances.Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts' consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions,searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline.Results:(1)The guideline development group made a Grade A recommendation that ①With a course of Bell's palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs,whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable.②Acupuncture should be applied as early as possible for Bell's palsy.③The principle of selecting acupoints for Bell's palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally,the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell's palsy,including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice.(2) The development group formed expert consensus on the principles of acupuncture treatment for Bell' palsy. Bell's palsy is suitably treated according to the stages, differentiation and symptoms.

Clinical Practice Guideline of Acupuncture for Herpes Zoster

BACKGROUND Herpes zoster （HZ）, also called shingles, zona and zoster, is a painful skin rash. It is a distinctive syndrome caused by reactivation of varicella zoster virus （VZV）. The reaction occurs when immunity to VZV declines because of aging or immunosuppression.~1） At this time the virus infects nerves （namely, the dorsal root ganglia） where it remains latent for years. It occurs in about one million people in the United States annually.（2） In China, few studies reported the prevalence of HZ and one article has mentioned the number was 1.4%0-4.8%.

中医适宜技术治疗脑卒中后偏瘫的循证临床实践指南

脑卒中是成年人死亡和残疾的主要原因之一。中医适宜技术在脑卒中后偏瘫的康复治疗中广泛应用,然而尚缺乏系统的、高质量的循证指南来指导这些实践。本指南根据《世界卫生组织指南制订手册》和《中西医结合诊疗指南制订手册》制定,遵循卫生保健实践指南的报告要求,并参照推荐分级的评估、制定与评价系统对证据质量及推荐强度进行分级。本指南组建了包括5个小组在内的跨学科工作团队,通过问卷、面对面专家会议和问题解构方法来选择指南中需要回答的关键临床问题。从25个关键问题中筛选出10个进行研究。基于系统评价的结果,考虑到证据的优缺点、干预成本、证据质量、患者偏好及价值观、多学科专家的反馈和共识,本指南提出了20条关于中医适宜技术在脑卒中后偏瘫康复治疗中应用的推荐意见。本指南主要面向中国各级医院和康复机构的医务工作者,专注于中医适宜技术在脑卒中后偏瘫康复治疗中的临床应用。

针灸治疗学微课辅助培养临床实践能力的策略

针灸临床实践能力是针灸治疗学课程乃至针灸专业教学效果的直观体现。课程目前存在临床场景还原难、实践教学资源与课堂教学契合度不足等问题,不利于培养学生的临床实践能力。微课是以短视频为主要形式的教学活动,具有情景化、时长短、针对性强的特点。它适用于知识点有内部逻辑完整性、在知识体系中分布较分散的操作技能类教学活动。因此,此文讨论采用微课实现针灸治疗学教学模式重塑的策略,以期实现针灸临床实践教学质量的提升。

我国循证针灸临床实践指南评价研究

目的对我国循证针灸临床实践指南透明度及报告完整度进行评价,以期进一步提升针灸临床实践指南的科学性与临床适用性。方法以我国循证针灸临床实践指南为研究对象,利用临床实践指南透明度评价工具及RIGHT for acupuncture进行评价。结果共纳入指南28部,其中4部在人员遴选阶段达到透明,2部在推荐意见形成过程达到透明,1部在指南报告过程达到透明,其余指南未达到透明;RIGHT for acupuncture结果显示,各领域平均报告率依次为基本信息(50.00%)、评审和质量保证(50.00%)、背景(46.75%)、推荐意见(40.18%)、证据(40.00%)、资助与利益冲突声明及管理(7.14%)、其他(4.76%)。结论我国循证针灸临床实践指南存在过程报告不清、方法学不完善或利益冲突管理欠缺的情况。在今后指南制定过程中,应不断完善针灸指南制定方法,提高指南质量和透明度。

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

针灸学临床实践教学改革探讨

作为中医学中一大特色学科,针灸学是一门临床实践运用性学科,传统的填鸭式教育和现今的快餐式学习早已无法满足优质针灸医师的培育。结合针灸学科的特色及现今的教学模式,可见加强临床实践教学改革、提高临床操作技能尤为重要。针灸教学改革包括先进教学设备的引进,教学模式、教学方式的改变,增加实验课课时以及加强实践教学。此文对针灸学教育方式不足进行整理分析,并对针灸教学改革方法进行探索。