Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common emergencies of the digestive system. With the continuous development of digestive endoscopy technology and widespread use of proton pump inhibitors, the morbidity and mortality of ANVUGIB have declined, but there are still numerous difficulties to be solved in clinical treatment. The International Consensus Group in 2019 updated the international consensus guideline in 2003 and 2010 with new clinical recommendations on fluid resuscitation, risk assessment, pre-endoscopic treatment, endoscopic treatment, drug therapy, and secondary prevention, etc. This paper interprets the update to provide references for the clinical treatment of ANVUGIB.
Based on the charming quality theories and characteristics of hospital outpatient services in China, this paper defined and analyzed the quality of hospital services, and then made several corresponding recommendations for improving charming quality of outpatient services. The aim is to explore an effective way to tap the potential needs of the patients and to retain some loyal patients, under the impact of the hospital competitiveness.
With the development of evidence-based medicine, an increasing amount of clinical care experts are paying attention to recommendations in the guidelines and the application of guidelines in clinical nursing practice. The demand for clinical practice guidelines is becoming increasingly important. Based on characteristics of nursing, this paper focuses on primary steps in the formulation of nursing-clinical practice guideline, such as clinical problems, outcomes, nursing evidence retrieval and selection, evidence and recommendations classification, methods from evidence to recommendations, patients' preference and value, and provides suggestions for development of nursing-clinical practice guidelines.
Evidence is the core of Evidence-Based Medcine; the Grades of Recommendations Assessment, Development and Evaluation (GRADE System) is a milestone in the history of evidence development. This paper outlines the GRADE System and GRADEpro 3.2 software, and briefly explores the right and wrong application which was published in the Chinese Journal of Evidence-Based Medicine. The GRADEpro 3.2 software is easy to operate, but for evaluating the reasons of upgrade and downgrade, and the importance of the parameters of outcomes, it needs to comprehensively and systematically understand the knowledge of relevant background, and to construct a solid foundation in clinical epidemiology and systematic review. In view of this paper based on the current GRADE System, there may be some discrepancy to the later content with the GRADE System constant improvement. Therefore, it is bly recommended that readers should keep constant learning and improving.
Research of generating real-world evidence using real world data has attracted considerable attention globally. Outcome research of treatment based on existing health and medical data or registries has become one of the most important topics. However, there exists certain confusions in this line of research on how to design and implement appropriate statistical analysis. Therefore, in the fourth chapter of the series technical guidance to develop real world evidence by China REal world data and studies Alliance (ChinaREAL), we aim to provide an guidance on statistical analysis in the study to assess therapeutic outcomes based on existing health and medical data or registries.In this chapter, we first emphasize the significance of pre-specified statistical analysis plan, recommending key components of the statistical analysis plan. We then summarize the issue of sample size calculation in this content and clarify the interpretation of statistical p-value. Secondly, we recommend procedures to be considered to tackle the issue related to the selection bias, information bias and most importantly, confounding bias. We discuss the multivariable regression analysis as well as the popular causal inference models. We also suggest that careful consideration should be made to deal with missing data in real-world databases. Finally, we list core content of the statistical report.
Currently, the recommendations of the clinical practice guidelines related to acupuncture in China and abroad are opaque to the source of the acupuncture prescription, there is a lack of comprehensive evaluation of the rationality of the acupuncture prescription, and the standards for the selection of the acupuncture prescription are opaque and nonstandard, and the writing and reporting details are insufficient, thus affecting the clinical applicability of the guidelines. To a certain extent, the utilization rate of the recommendations of the guidelines is low. This paper discusses the origin, rationality comprehensive evaluation, priority selection, writing and reporting of acupuncture prescriptions, and puts forward detailed methodological suggestions, to provide guidance makers of methodological optimization thoughts and suggestions for the evaluation, selection and writing of acupuncture prescriptions in the recommendations.
ObjectiveTo investigate the recommendations on imaging diagnosis in Chinese clinical practice guidelines (CPGs). MethodsWe electronically searched WanFang Data, VIP, CNKI and CBM databases from inception to December 31, 2014. Two reviewers independently screened literature and extracted data. The method of bibliometrics was used to analyze the data (including basic characteristics, strength of recommendation, quality of evidence, etc.). ResultsA total of 341 CPGs formulating the recommendations on diagnosis were included. 48.7% (166/341) guidelines developed the recommendations on imaging diagnosis (a total of 534). 25.7% (137/534) recommendations were with the symbols of quality of evidence and strength of recommendation, and 18.9% (101/534) with special words such as recommend, suggest. 22.3% (119/534) recommendations reported the strength of recommendation. Of which, 38.7% (46/119) were strong and 16.0% (19/119) were weak. However, 23.9% (11/46) strong recommendations were based on low quality of evidence. And 42.1% (8/19) weak recommendations were based on high quality of evidence. ConclusionAmong Chinese CPGs formulating the recommendations on diagnosis, the number of CPGs with recommendations on imaging is about 50%. And the quantity increases by years. The proportions of recommendations on imaging which report the strength of recommendation and/or quality of evidence are low. Meanwhile, the rating systems are uniform. Then the developers do not report the explanation for the strong recommendations based on low quality of evidence or the weak recommendations based on high quality of evidence in guideline.
A systematic literature search and a comparative study were conducted to investigate the evolution of the levels of evidence and strength of recommendations in medical research. Fifty systems were included from 1979 to 2007, and 11 of these, which came from five states or international organizations, were selected and divided into three stages according to their characteristics, sphere of influence and application fields. Ideas about levels of evidence and strength of recommendations are becoming mature in medical research. The challenge for the future is how to introduce evidence-based principles and develop the corresponding levels of evidence and strength of recommendations in the fields of management, education, basic medical sciences, economics, sociology and legal research.
Currently, there is a lack of clarity and standardization regarding the implementation details of interventions in traditional Chinese medicine clinical practice guidelines (CPGs). This in methodological guidance for standardizing the implementation prescription adversely impacts the quality of implementation and hinders the clinical application rate of recommendations. Through in-depth analysis of implementation prescription of evidence-based CPGs in traditional Chinese medicine, we identified the challenges associated with standardization. In response, we propose enhancing the technical specifications of implementation prescriptions, advocating for improved formulation processes, diverse reporting approaches, and standardizedological guidelines. These recommendations aim to serve as a methodological reference and guidance for clinical practice guideline developers.