Radiation proctopathy, which can be categorized as acute and chronic, is defined as the radiation damage to the rectum caused by radiation therapy in patients with pelvic malignancies. Chronic radiation proctopathy can cause complications such as rectal bleeding, which severely affects patients’ quality of life. At present, endoscopic therapy has become the primary method for diagnosis and treatment of bleeding from chronic radiation proctopathy. In October 2019, the American Society for Gastrointestinal Endoscopy (ASGE) published "ASGE guideline on the role of endoscopy for bleeding from chronic radiation". The guideline described the effectiveness and safety of different endoscopic therapies such as argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, cryoablation, etc. in the treatment of bleeding from chronic radiation. This paper interprets it to provide references for clinicians in the treatment of bleeding from chronic radiation.
Respiratory oscillometry is a lung function test that measures the mechanical properties of respiratory system by the forced oscillation technique. Oscillometry can be used in those who cannot perform traditional lung function tests, including young children. It is also an important tool to assess small airways function in clinical and research fields. In 2020, the European Respiratory Society published a new technical standard for respiratory oscillometry, which offered updated technical recommendations on the hardware, software, testing protocols and quality control of oscillometry measurements. This paper interpreted the new technical standard, for providing technical suggestions regarding oscillometry measurements in clinical and research settings, and as a reference for developing technical statements and recommendations for oscillometry in China.
Since 2016, the guidelines for the management of adults with hospital-acquired pneumonia (HAP) / ventilator-associated pneumonia (VAP) have been updated in the United States, Europe, and China, respectively. The differences among these guidelines are demonstrated in this paper. The definition of VAP, how to evaluate the effect of anti-infection therapy, and the prevention strategy are controversial. The consensuses contain diagnostic value of respiratory secretions achieved by noninvasive way for VAP and shorter anti-infection course for VAP. Importantly, pathogenic spectrum for HAP in China is different from others, which is essential for clinical practice.
The development of evidence-based social care guidelines need to follow certain standards and procedures, the process must be objective, fair, and transparent to ensure that guidelines are developed, scientific, timely, and available. Currently, many organizations have issued standard methods for developing guidelines, but the methods are mainly focused on clinical practice, and few methodological studies on the development of social care guidelines. To promote the development of evidence-based social care guidelines in China and strengthen the transformation from research to practice, this article is based on the "Social Care Guidance Manual" published on the NICE website, combined with the actual situation of domestic social care, inviting domestic evidence-based social science research experts to discuss and specifically introduce the development methods of evidence-based social care guidelines, and this article takes the "Guidelines for Providing Social Work Services to Adults with Complex Needs" as an example, interpreting the process for developing guidelines to make the guide development method more transparent.
China Association of Chinese Medicine officially issued the Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine-Headache (T/CACM 1271-2019) on January 30th, 2019. The guideline provided 27 recommendations, including clinical diagnosis, treatment, prevention and care of headache. This paper introduces the background of this guideline and interprets its contents of clinical diagnosis, treatment and prevention.
Directed acyclic graphs (DAGs) are essential tools based on prior assumptions, capable of clearly depicting causal relationships between variables, aiding in the identification of confounders and assessment of bias. They have been widely applied in the field of epidemiology. However, the construction of DAGs is prone to the subjectivity of researchers. This paper interprets the DAGs construction and application guidelines from the BMJ and elaborates on the seven steps for building DAGs: clarifying the research question and target population, identifying relevant variables, reaching consensus and pre-registering, determining data collection or datasets based on the consensus graph, selecting analysis methods and variable measurement, conducting sensitivity analysis, and reporting the DAGs. By following these steps, researchers can construct DAGs more scientifically, identify the minimal sufficient adjustment set, and enhance the scientific validity and reliability of their studies. Despite its advantages, DAGs have limitations. For instance, failure to consider all relevant factors may lead to unexplained disturbances in the analysis results or incorrect causal inferences, thus failing to verify other key assumptions in causal reasoning. Therefore, it is recommended to integrate DAGs with data-driven methods to maximize their strengths and compensate for their shortcomings.
Due to the special structure and material of the flexible gastrointestinal (GI) endoscopes, it is difficult to reprocess endoscopes. Infections caused by endoscope reprocessing failure often occur. Strict implementation of the guidelines/relevant national standards and manufacturer's instructions is essential to prevent the occurrence of endoscopy-related infections and ensure patient safety. In 2020, ASGE (American Society for Gastrointestinal Endoscopy) released the "multisociety guideline on reprocessing flexible GI endoscopes and accessories". This paper aimed to promote the understanding of the reprocessing process of flexible GI endoscopes by the endoscope decontamination staff, and to provide references for clinical practice.
Gout is the most common inflammatory arthritis, which is characterized by elevated urate and monosodium urate (MSU) crystal deposition in tissues, leading to arthritis, soft-tissue masses (tophi), nephrolithiasis, and urate nephropathy. It has a major impact on health-related quality of life. The American College of Rheumatology (ACR) published ACR guidelines for the management of gout in June 2020, in which 42 recommendations (including 16 strong recommendations) were generated. The guideline described indications for urate-lowering therapy (ULT), approaches to initiating, ongoing management, gout flares, and lifestyle and other medication strategies in patients with gout and in individuals with asymptomatic hyperuricemia. This paper interprets it to provide references for clinical practice.
