Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China(Issue 7.0)

Diabetic foot(DF)is one of the most common complications of diabetes and is associated with high morbidity,disability,lethality and low cure-rate.The clinical diagnosis and treatment of DF need to be standardized.The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF,which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China.In line with the latest developments in diagnosis and treatment,the Alliance,along with other 89 institutions,developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.

Diagnosis and treatment protocol for COVID-19 patients(Tentative 10th Version)

To further improve the diagnosis and treatment of COVID-19,the National Health Commission of People's Republic of China and the National Administration of Traditional Chinese Medicine convened a group of experts to revise the relevant content of the Diagnosis and Treatment Protocol for COVID-19 Patients(Trial Version 9)and developed the Diagnosis and Treatment Protocol for COVID-19 Patients(Trial Version 10),summarizing the etiological characteristics,epidemiological characteristics,prevention,clinical features,diagnosis,clinical classification,population with high risk of severe/critical illnesses,early warning predictors for severe/critical illnesses,differential diagnosis,case identification and reporting,treatment,nursing,control of nosocomial infection in medical institutions,and discharge criteria for inpatients.

Diagnosis and treatment protocol for COVID-19 patients(Trial Version 9)

To further improve the diagnosis and treatment of COVID-19,China National Health Commission and the National Administration of Traditional Chinese Medicine convened a group of experts to revise the relevant content of the Diagnosis and Treatment Protocol for COVID-19 Patients(Trial Version 8)and developed the Diagnosis and Treatment Protocol for COVID-19 Patients(Trial Version 9),summarizing the etiological characteristics,epidemiological characteristics,pathological changes,clinical features,diagnosis,clinical classification,population with high risk of severe/critical illnesses,early warning predictors for severe/critical illnesses,differential diagnosis,case identification and reporting,treatment,nursing,discharge criteria and precautions after discharge,patient transfer,control of nosocomial infection in medical institutions,and disease prevention.

Evolution and major changes of the diagnosis and treatment protocol for COVID‐19 patients in China 2020–2023

Since the identification of the first case of pneumonia of unknown cause in 2019,the COVID‐19 pandemic has spread the globe for over 3 years.As the most populous country in the world,China's disease prevention policies and response plans concern the health of the country's 1.4 billion people and beyond.During the course of the pandemic,scientific research has been accumulated and given evidence‐based support to the official guidance of COVID‐19 management.The National Health Commission of China have compiled,published,and updated a total of 10 versions of the“Diagnosis and Treatment Protocol for COVID‐19 Patients”to better inform clinical practitioners and staff to effectively screen,diagnose,manage,treat,and care for cases of severe acute respiratory syndrome coronavirus 2 infection.This paper compares and summarizes each version of the protocol in terms of etiology and epidemiology,clinical manifestation and diagnosis,treatment and nursing,disease control and management,presenting detailed changes,additions,deletions,and refinement of the protocols.

2019 Chinese clinical guidelines for the management of hepatocellular carcinoma: updates and insights

Importance:Approximately half of newly-diagnosed hepatocellular carcinoma(HCC)cases in the world occur in China,with hepatitis B virus(HBV)infection being the predominant risk factor.Recently,the guidelines for the management of Chinese HCC patients were updated.Objective:The past decade has witnessed a great improvement in the management of hepatocellular carcinoma(HCC).This study reviews the recommendations in the 2019 Chinese guidelines and makes comparison with the practices from the Western world.Evidence Review:The updated recommendations on the surveillance,diagnosis,and treatment algorithm of HCC in the 2019 Chinese guidelines were summarized,and comparisons among the updated Chinese guidelines,the European Association for the Study of the Liver(EASL)and the American Association for the Study of Liver Diseases(AASLD)guidelines were made.Findings:Besides imaging and pathological diagnoses,novel biomarkers like the seven-micro-RNA panel are advocated for early diagnoses and therapeutic efficacy evaluation in the updated Chinese guidelines.The China liver cancer(CNLC)staging system,proposed in the 2017 guidelines,continues to be the standard model for patient classification,with subsequent modifications and updates being made in treatment allocations.Compared to the Barcelona Clinic Liver Cancer(BCLC)system,the CNLC staging system employs resection,transplantation,and transarterial chemoembolization(TACE)for more progressed HCC.TACE in combination with other regional therapies like ablation or with systemic therapies like sorafenib are also encouraged in select patients in China.The systemic treatments for HCC have evolved considerably since lenvatinib,regorafenib,carbozantinib,ramucirumab and immune checkpoint inhibitors(ICIs)were first prescribed as first-line or second-line agents.Conclusions and Relevances:Novel biomarkers,imaging and operative techniques are recommended in the updated Chinese guideline.More aggressive treatment modalities are suggested for more progressed HBV-related HCC in China.

A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights

Significant improvements in the management of hepatocellular carcinoma(HCC)during the past three years have urged the timely update of clinical guidelines in China.In brief,aMAP score is newly recommended as an effective risk stratification tool to predict HCC occurrence especially for non-cirrhotic patients.Biomarker-based surveillance including 7 micro-RNA panel and GALAD score are advocated to assist early diagnosis.China liver cancer(CNLC)staging system proposed in the 2017 guideline continues to be the standard model for staging with modifications in the treatment allocations.Conversion therapies using multi-modal,high intensity strategies are advocated to facilitate subsequent resection for patients with technically unresectable CNLC stage Ia,Ib,IIa HCC,or technically resectable IIb,IIIa HCC.Super-selective transcatheter arterial chemoembolization(TACE)with the assistance of Cone-Beam CT if necessary is recommended to guarantee the efficacy of TACE.Hepatic arterial infusion chemotherapy(HAIC)using oxaliplatin,fluorouracil,and leucovorin(FOLFOX)regimen alone or in combination with systemic therapy is recommended for TACE-refractory patients or for patients with locally advanced HCC.The systemic treatments for HCC have evolved considerably since atezolizumab plus bevacizumab,and suntilimab plus bevacizumab analogue showing superior survival benefit to sorafenib,and donafenib with comparable efficacy with sorafenib are added to the first-line treatments.In addition to regorafenib,apatinib,camrelizumab and tislelizumab are added as the second-line systemic therapies for patients who progressed on sorafenib.Updates in the 2022 Barcelona Clinic Liver Cancer(BCLC)guidelines and Japanese Society of Hepatology(JSH)consensus statement are also introduced and compared with the 2022 Chinese guidelines.

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.

《膝骨关节炎针刀临床诊疗指南》解读

膝骨关节炎(KOA)是一种以关节软骨退变、继发性骨赘形成、软骨下骨硬化、滑膜炎症等为主要特征的慢性退行性疾病。针刀可通过多途径、多靶点松解刺激,解除应力集中点,恢复膝部力学平衡,改善KOA患者功能,是临床治疗KOA的有效方式之一。中华中医药学会针刀医学分会提出的《膝骨关节炎针刀临床诊疗指南》(简称《指南》)首次较为完整地对针刀临床诊疗方案进行规范梳理,更好地为KOA临床决策与实践提供可靠的证据参考。为进一步推广与应用该《指南》,本研究从《指南》制定目的和意义、临床安全性、临床适用范围、推荐诊疗方案、不良反应标准化处理等方面进行解读,以期提高针刀在KOA诊疗中的应用水平。重点解读了针刀在KOA诊疗中的适用范围与禁忌证、针刀治疗KOA操作规范化要求、KOA分期针刀诊疗方案、针刀诊疗方案和规范治疗点选择、针刀治疗KOA注意事项、《指南》的临床适用性及有效性、存在的不足及发展建议等内容,促进《指南》在KOA临床诊疗中的应用。

糖尿病足介入综合诊治临床指南(第九版)

糖尿病足作为糖尿病血管病常见并发症之一,具有高发病率、高致残率、高致死率和治愈率低的特点,严重影响糖尿病患者的身心健康和生活品质,却一直缺少统一的规范性治疗方法。中国糖尿病足细胞与介入治疗技术联盟曾于2015年制定了糖尿病足介入综合诊治临床指南(第一版),在一定程度上填补了国内糖尿病足规范性治疗的空白,对于提高我国糖尿病足治疗水平起到了支撑作用。近10年来,随着诊断标准和治疗方式的更新,以及国内外相关研究的不断深入,联盟组织国内89家单位在第八版的基础上进行新的修订,并颁布第九版指南,以期进一步规范我国糖尿病足临床诊治工作。本指南较第八版主要增加了糖尿病足下肢动脉狭窄或闭塞的腔内治疗原则,强调血管重建优先重建直线血流的原则,至少建立1支能够从股浅动脉起始端到达足部病变部位的直接供血动脉,对于膝下动脉多支病变治疗时建议遵循“先易后难”的重建原则,先处理容易开通的病变动脉,保证至少有1支血管能够供应到足部。同时本版指南介绍了同济大学“五点法皮温”设备在糖尿病足诊治中的巨大应用价值。

基于德尔菲法确定《子宫腺肌病中西医结合诊疗指南》的临床问题

目的:基于德尔菲法形成《子宫腺肌病中西医结合诊疗指南》的临床问题,形成子宫腺肌病的规范性、实用性中西医结合诊疗指南。方法:基于德尔菲法,结合前期文献研究结果,采用问卷星编制调查问卷,向全国13个省(市、自治区)的34名专家进行两轮函询。结果:两轮德尔菲法均发放34份问卷,问卷回收率为100%,两轮函询积极系数均为100%,权威系数均>0.70,变异系数分别为0.00~0.38、0.13~0.37,肯德尔和谐系数分别为0.229、0.100(P<0.05);共形成了30个临床问题,凝练后最终形成10个必须在指南中形成推荐意见或说明的临床问题。结论:本研究通过两轮德尔菲法调查确定了需要纳入《子宫腺肌病中西医结合诊疗指南》的临床问题,为指南的后续制定工作奠定了良好基础。

中西医结合神经根型颈椎病诊断与非手术治疗指南(2023年)计划书

神经根型颈椎病(cervical spondylotic radiculopathy,CSR)是中西医结合医学的常见优势病种之一,但现有的CSR指南/共识均未提供与CSR中西医结合诊疗相关的建议。为帮助不同医学体系下的从业者更好地进行CSR中西医结合诊疗决策,亟需制订基于循证医学证据的临床实践指南。本指南计划书介绍了项目组遵照循证指南制订的原则、方法制订《中西医结合神经根型颈椎病诊断与非手术治疗指南(2023年)》的各个关键环节,旨在为科学制订本指南提供指导性和纲要性的实施方案,促进本指南规范、高效、透明化开展。

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.

成年女性压力性尿失禁诊疗的临床实践指南内容分析

目的总结成年女性压力性尿失禁(SUI)诊断和治疗的循证证据和推荐意见。方法以关键词压力性尿失禁/尿失禁(UI)、临床实践指南/最佳实践/共识,检索美国指南网(NGC)、Cochrane图书馆(CL)、JBI循证卫生保健数据库、Medline、中华人民共和国卫生部网站及中国生物医学文献数据库等。采用内容分析法,对检索出的相关临床实践指南进行文献内容分析。结果共纳入11个临床实践指南,对成年女性SUI的诊断和治疗方面总结出具体的循证证据和推荐意见。结论应结合我国实际和最佳证据,构建适合本土成年女性SUI诊疗的临床实践指南。

基于成本-效果分析评价类风湿关节炎中医临床诊疗指南方案

目的评价类风湿关节炎中医临床诊疗指南方案的临床适用性。方法 120例患者随机分成干预组和对照组,每组60例。对照组给予常规治疗,干预组在常规治疗基础上加用类风湿关节炎中医临床诊疗指南方案进行干预,观察治疗前后血沉(ESR)、C反应蛋白(CRP)及简化的疾病活动指数(SDAI)评分改善值变化,并运用卫生经济学的成本-效果分析方法进行评价。结果临床效果方面:干预组总有效率明显高于对照组,而且ESR改善值、CRP改善值、SDAI评分改善值明显优于对照组(均P﹤0.05)。经济性方面:干预组住院平均日、诊疗费用低于对照组(均P﹤0.05),但平均每日住院成本干预组高于对照组;干预组在成本效果比、增量成本比均低于对照组,差异有统计学意义(均P﹤0.05)。结论中医临床诊疗指南方案可提高类风湿关节炎临床有效性、经济性,值得临床推广。

诊治指南为基础的教学方法在泌尿外科研究生临床实习教学中的应用

目的以诊治指南为基础,提高临床实习教学效果。方法将本科实习的泌尿外科研究生分为2组,实验组采用以诊治指南为基础进行教学,对照组采用传统方法带教,一定时间后,采用试卷加问卷的形式进行考核,比较两组之间的区别。结果实验组基础理论考试成绩优于对照组,临床病例分析优于对照组。临床技能考试两组无明显区别。问卷结果表明,学生更乐意接受以诊治指南为基础的教学方法。结论 以诊治指南为基础的临床实习带教可以提高泌尿外科临床实习效果,增强学生的学习兴趣。

临床诊疗指南结合病例分析在妇产科规范化培训中的应用

住院医师规范化培训是医学生毕业后继续教育的必要环节,是临床思维形成和基本技能锻炼的重要时期。临床诊疗指南是按照循证医学的方法开发出的一组临床指导意见,是临床医生从事临床工作的重要纲领性文献,住院医师需重点掌握和熟练应用。将临床诊疗指南融入到病例分析中,运用于妇产科住院医师培养,可有效节约住院医师的宝贵时间,提高学习效率,有助于临床思维能力和自学能力的培养。文章以10例"宫腔粘连"的病例讨论为例,分析病例讨论与临床诊疗指南相结合在妇产科住院医师学习中的重要性。

《循证针灸临床实践指南(原发性三叉神经痛)》编制难点与对策

[目的]总结《循证针灸临床实践指南（原发性三叉神经痛）》编制中的关键点、难点,介绍指南推荐意见产生的背景及依据,并为中医药循证临床实践指南的制定和解读提供参考。[方法]运用循证医学理念及方法,对针灸治疗原发性三叉神经痛的诊疗方案研究进行回顾性分析。充分探究2010~2015年编写原发性三叉神经痛针灸临床实践指南过程中遇到的难点,选择本指南制定过程中具有代表性的4个关键问题和难点,包括如何产生指南临床问题、指南目标人群的选择、文献检索策略的制定、文献评价及推荐标准的选择进行对策探讨。[结果]针灸治疗原发性三叉神经痛临床研究证据质量较低,现代研究证据难以回答指南中的全部问题、全面反映针灸治疗三叉神经痛的临床特色,中医药指南制定过程中有多个难点需要解决。中医药指南制定的过程不仅参考了现有循证医学指南制定方法,还选择了能够反映中医药特色的评价方法。在对文献进行循证评价的基础上,选择问卷调查、小组讨论、专家共识等方法为指南推荐意见的产生提供依据。[结论]中医药循证临床实践指南的制定需与中医药疗法自身具备的特点相符,目前循证针灸临床实践指南的制定方法还待进一步完善,针灸临床研究证据的论证强度还待进一步加强。

基于德尔菲法的《产后痹中医临床诊疗指南》问卷调查与结果分析

目的运用德尔菲法对中医产后痹的辨证、治疗等进行专家调查问卷,形成科学合理、规范实用的《中医临床诊疗指南·产后痹》。方法基于德尔菲法,结合前期文献研究结果,编制第一轮问卷;按照要求遴选对中医产后痹有专长的专家,包含中医风湿病学、中西医结合风湿病学、中医文献学等领域,征求专家意见;在回收专家反馈意见后,对问卷条目进行统计分析,从专家意见集中程度和专家意见协调程度两方面进行观测。结果调查问卷回收有效问卷40份,专辑积极系数为83. 33%,专家对其中部分指标集中程度与协调程度较高。结论专家的积极性较高,分布地区广,具有代表性。通过运用德尔菲法进行中医产后痹辨证论治规范化的研究,形成产后痹中医临床诊疗指南的雏形。

不寐的中医药标准化诊疗思考

随着社会压力的不断增加,不寐的发病率日益增长,严重损害人们的身心健康,影响生活质量。从古至今,历代医家对不寐的学术观点存在一定的差异,有着其独特的辨证思维方法,现阶段不寐的中医药诊疗标准临床指导性还不够规范,其可操作性有待提高,缺少循证医学证据支持等现存诸多问题对普及和推广不寐的中医药标准化诊疗形成了一定的阻碍,笔者通过查阅从古至明清涉及不寐的的相关古籍、整理归纳近现代名家对不寐的辨证诊疗思路,从病名证候、分型论治、治法方药等方面进行总结,希冀可以通过本篇文章为不寐的中医药标准化诊疗方向提供思路,进而确定更加规范合理、更具临床指导意义的标准化诊疗方案。

循证性小儿鼻鼽中医临床诊疗指南编制技术与实践

按照本团队提出的"与国际接轨,体现中医行业特点"的循证中医临床诊疗指南研制技术方法,开展文献研究(文献检索,文献评价,文献总结),三轮Delphi法专家问卷调查提出草稿,专家认证会形成初稿,全国行业专家征求意见形成评价稿,专家质量方法学AGREEⅡ工具评价、12个医疗机构210例临床一致性评价形成草案,向全国网上征求意见,形成送审稿,研制成《中医儿科临床诊疗指南·小儿鼻鼽》。编制技术与实施方法可供中医临床诊疗指南制订借鉴。