Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Teaching Reform and Exploration of Practical Courses Based on Programmable Control

As the country continues to promote the development of intelligent manufacturing,all industries are carrying out enterprise automation upgrading,the Pearl River Delta Intelligent Manufacturing Conference held in March 2024 provides a direction guide for each enterprise on how to integrate the intelligent manufacturing technology into each link and provide direction guidance for enterprises to create new models and new business formats.College teachers,in focusing on the teaching process,should closely match the enterprise and social needs and cultivate excellent students.As the core controller of automation control,the application of programmable controllers in teaching is particularly important.In practical classes,by setting progressive difficulty,project guidance,team collaboration,and other links,students can master the automation equipment design of programmable control in repeated practice.

Development of a Sports Safety Promotion Framework Based on KABP Theory and 4M Management

This study explores the significance,current research landscape,and conceptualization of sports safety promotion.Safety in sports is fundamental to youth physical activities,and an excessive focus on or neglect of safety is unwarranted.Globally,numerous countries have extensively researched sports safety promotion and implemented diverse strategies.Drawing from KABP(Knowledge,Attitude,Behavior,Practice)theory and 4M(Man,Machine,Medium,Management)management,this paper presents a conceptual framework for sports safety promotion.It integrates these theories to devise a comprehensive accident prevention model within a sports safety promotion system.The framework prioritizes enhancing students’safety literacy and underscores the practical application of safety knowledge and skills in simulated sports settings following structured safety education.It aims to enhance students’competency and proficiency in averting sports-related injuries.

An Evaluation of the Core Controversies in Contemporary Western Human Rights Theory——A Study Based on the Examination of the Criterion of Fidelity to Practice

The development of theories on human rights with Chinese characteristics and China’s engagement in global human rights governance cannot be separated from attention to contemporary Western human rights theory.The debate between naturalistic and political conceptions of human rights has a long history,but discussions on the basic criteria for evaluating human rights theories have been insufficient.This article,focusing on the criterion of fidelity to practice,attempts to identify the development trajectory and direction of human rights theory.The universal claims of naturalistic human rights perspectives and the human rights catalog they propose have been criticized for deviating from practice.On the other hand,political conceptions of human rights,while emphasizing domestic human rights practices,have been criticized for their occasional nature and perceived loss of criticality.The broad-way practice theory seeks a third way that goes beyond the divide between these two perspectives.On the one hand,the theory itself faces limitations and the need for reshaping,while on the other hand,the traditional singular practice theory is also undergoing self-renewal.It can be said that the“internal critique”of contemporary Western human rights theory is already underway and will continue.

Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy

Primary liver cancer and liver metastases are among the most frequent malignancies worldwide,with an increasing number of new cases and deaths every year.Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy.This synopsis outlines the first clinical practice guidelines for ultrasoundguided percutaneous microwave ablation therapy for hepatic malignancy,which was created by a joint task force of the Society of Chinese Interventional Ultrasound.The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment,as well as proposing the criteria for the treatment candidates.

THEORY AND PRACTICE FOR COMPILING THE ATLAS OF NATURAL DISASTERS IN CHINA

This article inquires into theoretical and practical problems on compilation of an atlas of regional natural disasters. (1) The basic theory of compiling an atlas of regional disasters has been founded on the combination of the sciences of disasters, cartography and regional geogrphy. The content structure of a regional disaster atlas should be composed of at least the following five parts:hazard-formative environments and hazard-affected bodies,hazards, disaster effects, monitoring and warning system for natural disasters, and countermeasures for natural disaster reduction. (2) Contents of cartographic design of a regional disaster atlas should be composed of at least the following five parts: base map system, cartographic representation, Symbol System, color system, map edition and map layout system. (3) Based on theory and cartographic design of compiling an atlas of regional disaster, the Atlas of Natural Disater in China, which reveals objectively the temporal and spaial pattern of regional natural disasters of China,has been compiled and published.

胃肠道手术ERAS指南/共识质量评价及内容分析

目的 通过评价和分析胃肠道手术加速术后康复(ERAS)指南/共识,遴选推荐使用的高质量指南/共识,为ERAS临床实践提供决策依据。方法 计算机检索PubMed、Embase、万方、中国知识基础设施工程等数据库及指南相关网站,纳入自数据库建库至2023年7月的胃肠道手术ERAS指南/共识。应用指南研究与评估系统Ⅱ和国际实践指南报告规范对纳入研究的指南/共识进行质量评价。分析整理推荐使用的高质量指南,汇总推荐意见。结果 最终纳入8部指南、13部共识。基于应用指南研究与评估系统Ⅱ,各领域平均标准化得分:范围和目的 64.22%±14.47%、参与人员29.68%±15.43%、制定的严谨性30.26%±18.76%、表达的明晰性73.68%±19.06%、应用性10.05%±11.39%、编辑独立性54.46%±36.58%,其中3部指南推荐使用。基于国际实践指南报告规范,指南背景、证据和推荐意见领域存在严重报告缺失(报告率<10%)。基于3部推荐使用的指南,汇总提出术前、术中和术后三部分24条推荐意见。结论 胃肠道手术ERAS指南/共识质量参差不齐,3部推荐使用。

Prospects for the future of clinical efficacy evaluation of traditional Chinese medicine——Emphasis on original theory and clinical practice

Traditional Chinese medicine(TCM)clinical efficacy evaluation runs through the development of TCM and has been progressing so far.With the introduction of evidence-based medicine(EBM)in recent 20 years,TCM clinical efficacy evaluation has developed rapidly,accumulated research and experience,improved the quality and standardization of research,but also gradually found deep-seated deficiencies.In 2019,the China Center for Evidence-based Traditional Chinese Medicine(CCEBTCM)was established,and TCM was included in the 11th revision of the International Statistical Classification of Diseases(ICD-11).In above opportunities for TCM clinical efficacy evaluation,it is necessary to face up to the previous deficiencies,so that the TCM clinical efficacy evaluation can truly reflect the actual clinical practice characteristics,including TCM clinical problems,TCM thinking and TCM diagnosis&treatment mode.Based on the summary and analysis of past research,development concepts are proposed in this article.On the one hand,original concepts of TCM should be confidently paid more attention to the design and implementation of TCM clinical efficacy evaluation to be close to TCM clinical practice.On the other hand,it is necessary to consolidate the foundation of TCM clinical practice before evaluating efficacy.Evaluated object built on TCM ontology knowledge should be demonstrated based on clinical practice,and unknown evaluated object combined with new methods,technologies and concepts should be maturely integrated in clinical practice firstly.

Construction and Practice of Online Course Resources Based on Information Processing Theory:Taking“A Bite of Teochew Cuisine,”a Guangdong First-Class Course,as an Example

“Cantonese Cuisine Master”project is an important policy proposed by China to inherit Cantonese Cuisine culture,promote employment,and achieve targeted poverty reduction and rural revitalization.Confronted with the demands of more diverse education,it is an essential opportunity and task for the education system to consider how to construct high-quality online courses and pursue higher-quality“Cantonese Cuisine Master”projects in line with the new era.This paper,based on the theory of instructional media and information processing theory,will further clarify the demand,dilemma,and developing strategy of online course construction for culinary majors,and explore its construction and practice with the example of“A Bite of Teochew Cuisine,”a Guangdong first-class course.

Research on the Application of Second Language Acquisition Theory in College English Speech Teaching

The teaching of English speeches in universities aims to enhance oral communication ability,improve English communication skills,and expand English knowledge,occupying a core position in English teaching in universities.This article takes the theory of second language acquisition as the background,analyzes the important role and value of this theory in English speech teaching in universities,and explores how to apply the theory of second language acquisition in English speech teaching in universities.It aims to strengthen the cultivation of English skilled talents and provide a brief reference for improving English speech teaching in universities.

Unraveling Predatory Pricing:Insights From Case Studies and Game Theory Modeling

This paper develops a game-theory model for predatory pricing via in-depth analyses of three case studies:Brooke Group Ltd.v.Brown&Williamson Tobacco Corp.,Matsushita Electric Industries Co.v.Zenith Radio Corporation,and AKZO Chemie BV v.Commission of the European Communities.This model is based on subsequent action game theory models and rational economics behavior,offering a chronological outline of the“predation”stages.It presents the predator’s decisions,the prey’s potential responses,possible loops,and the two distinctive outcomes.The analysis of the model in context of the three case studies demonstrates its practicality in assessing real-life predatory pricing scenarios and players’strategies.It’s flexibility also allows applications in related fields.Overall,this paper offers a comprehensive framework that bridges the gap between law,economics,and game theory in the study of predatory pricing,informing future research in this area.

Research on the Reform of“Traditional Chinese Medicine Nursing”Teaching Based on the Concept of Outcome-Based Education

Continuously evolving teaching concepts and the adoption of diverse teaching methods have led to outcome-oriented education becoming a fundamental focus of teaching reform in colleges and universities.In this article,the“Traditional Chinese Medicine Nursing”course is used as an example to discuss the reform of education based on the concept of outcome-based education,with the purpose of improving students'learning outcomes and practical skills.

Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update

In 2010, a panel of Chinese pathologists reported the first expert consensus for the pathological diagnosis of primary liver cancers to address the many contradictions and inconsistencies in the pathological characteristics and diagnostic criteria for PLC. Since then considerable clinicopathological studies have been conducted globally, prompting us to update the practice guidelines for the pathological diagnosis of PLC. In April 18, 2014, a Guideline Committee consisting of 40 specialists from seven Chinese Societies(including Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Pathology, Chinese Anti-Cancer Association; Digestive Disease Group, Chinese Society of Pathology, Chinese Medical Association; Chinese Society of Surgery, Chinese Medical Association; Chinese Society of Clinical Oncology, Chinese Anti-Cancer Association; Pathological Group of Hepatobiliary Tumor and Liver Transplantation, Chinese Society of Pathology, Chinese Medical Association) was created for the formulation of the first guidelines for the standardization of the pathological diagnosis of PLC, mainly focusing on the following topics: gross specimen sampling, concepts and diagnostic criteria of small hepatocellular carcinoma(SHCC), microvascular invasion(MVI), satellite nodules,and immunohistochemical and molecular diagnosis. The present updated guidelines are reflective of current clinicopathological studies, and include a novel 7-point baseline sampling protocol, which stipulate that at least four tissue specimens should be sampled at the junction of the tumor and adjacent liver tissues in a 1:1 ratio at the 12, 3, 6 and 9 o'clock reference positions. For the purposes of molecular pathological examination, at least one specimen should be sampled at the intratumoral zone, but more specimens should be sampled for tumors harboring different textures or colors. Specimens should be sampled at both adjacent and distant peritumoral liver tissues or the tumor margin in order to observe MVI, satellite nodules and dysplastic foci/nodules distributed throughout the background liver tissues. Complete sampling of whole SHCC ≤ 3 cm should be performed to assess its biological behavior, and in clinical practice, therapeutic borders should be also preserved, even in SHCC. The diagnostic criteria of MVI and satellite nodules, immunohistochemical panels, as well as molecular diagnostic principles, such as clonal typing, for recurrent HCC and multinodule HCC were also proposed and recommended. The standardized process of pathological examination is aimed at ensuring the accuracy of pathological PLC diagnoses as well as providing a valuable frame of reference for the clinical assessment of tumor invasive potential, the risk of postoperative recurrence, long-term survival, and the development of individualized treatment regimens. The updated guidelines could ensure the accuracy of pathological diagnoses of PLC, and provide a valuable frame of reference for its clinical assessment.

Conclusions in Theory and Practice for Advancing the Applications of Cable-Driven Mechanisms

The theoretical research of cable-driven mechanisms is developed with its broad applications. The first prototype of cable-driven mechanisms is RoboCrane, which was developed by the National Institute of Standards and Technology （NIST）. Then many excellent properties were developed and they have a variety of applications such as aerospace, aircraft and automobile industries [1]. Example application for RoboCrane in the field of aircraft mainte- nance is equipped with a quick-change mechanism to remove the robot arm remotely.

On Treatment Patterns for Modeling Medical Treatment Processes in Clinical Practice Guidelines

Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.

An Analysis of the Application of the Suggestions of Clinical Practice Guideline for Ostomy Care in China:A Cross-Sectional Investigation

Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.

Clinical practice guidelines for the interventional treatment of advanced pancreatic cancer(5^(th)edition)

Pancreatic cancer has become a major disease affecting people’s health because of its insidiousness,rapid progression and poor prognosis.Based on the practical needs of clinical work,combined with domestic multi-center research and experience,this guideline provides constructive suggestions for the interventional treatment of pancreatic cancer.

The Basis of Atherosclerotic Guidelines—Time for a Change?

Major advances have occurred within the last decade in the understanding of the pathogenesis of coronary artery disease. Not only are the underlying mechanisms now clearly defined, but effective medical therapies are available at low cost and minimal side effects. In spite of these advances, cardiovascular events are still the leading cause of death in the United States and the Western world. Analysis of the many factors involved in the delivery of appropriate cardiovascular care strongly suggests that the primary reason is the overly restrictive guidelines published by medical societies. This article proposes a much broader basis for constructing atherosclerosis clinical guidelines, namely the known pathophysiology of atherosclerosis. If pathophysiology forms the basis of atherosclerotic treatment recommendations, then a risk/benefit analysis can be used to determine appropriate preventive therapy for any specific individual. The result will be that many additional individuals will be eligible for preventive treatment of atherosclerosis, and the saving of many lives at minimal cost will result.

Efficacy of a Strategy for Implementing Guidelines for the Control of Cardiovascular Risk in Primary Healthcare

Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinion leaders, and the habitual method of dissemination among primary healthcare teams. Design and Setting: Controlled, blinded, community intervention trial randomised by clusters. Methods: 21 primary healthcare centres were randomly assigned to either the intervention arm (n = 11) or the control arm (n = 10). The study subjects were patients aged ≥45 years assigned to the centres. The overall impact of the intervention was measured as the difference between the increase in the proportion of patients whose medical records showed the recording of all the variables necessary to calculate cardiovascular risk in both arms. Analyses were performed with Generalized Lineal Model on an intention-to-treat basis. Results: 917 subjects were included at the beginning of the trial (437 in the intervention arm and 480 in the control arm). 826 subjects were included in the final evaluation (436 in the intervention group and 390 in the control arm). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group (difference between increases 7.49% (95% CI 4.62 - 10.35)) after adjusting for confounding variables. Conclusions: Compared to the habitual method of dissemination, the implementation of this CPG using an educational method involving opinion leaders, improved the recording of the variables needed to calculate patients’ cardiovascular risk.