Objective:This study aimed to systematically evaluate the measurement characteristics and methodological quality of childbirth experience assessment tools,with a view to informing the selection of healthcare professio...Objective:This study aimed to systematically evaluate the measurement characteristics and methodological quality of childbirth experience assessment tools,with a view to informing the selection of healthcare professionals who can provide high-quality assessment tools.Method:A systematic search was performed on specific databases:PubMed,Web of Science,Embase,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),and Wanfang,from inception to February 29,2024.The researchers retrieved studies on the measurement attributes of the childbirth experience assessment tool,and traced back the references of the included studies to supplement relevant literature.According to the inclusion and exclusion criteria,screening and data extraction were independently undertaken by two reviewers.Two researchers individually used the Consensus-based Standards for the Selection of Health Measurement Instruments(COSMIN)Risk of Bias Checklist to assess the methodological quality of the scale,applied the COSMIN criteria to evaluate the measurement properties of the scale,and used a modified Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system to assess the certainty of evidence.Result:A total of 15 studies were included to evaluate the psychometric properties of 11 childbirth experience assessment tools(including different language versions).Eight studies’methodological quality of content validity was doubtful,and the remaining studies did not report content validity.None of the tools reported measurement error,cross-cultural validity,or responsiveness.In light of the questionable or unreported content validity of the tools,the evidence quality was deemed moderate or below.Consequently,the 11 assessment tools were recommended as grade B.Conclusion:In contrast,the Questionnaire for Assessing the Childbirth Experience(QACE)is recommended for provisional use,given its relatively good methodological and measurement attributes and appropriate content for evaluation.However,further validation of other measurement properties is needed.展开更多
Brazing filler metals are widely applied,which serve as an industrial adhesive in the joining of dissimilar structures.With the continuous emergence of new structures and materials,the demand for novel brazing filler ...Brazing filler metals are widely applied,which serve as an industrial adhesive in the joining of dissimilar structures.With the continuous emergence of new structures and materials,the demand for novel brazing filler metals is ever-increasing.It is of great significance to investigate the optimized composition design methods and to establish systematic design guidelines for brazing filler metals.This study elucidated the fundamental rules for the composition design of brazing filler metals from a three-dimensional perspective encompassing the basic properties of applied brazing filler metals,formability and processability,and overall cost.The basic properties of brazing filler metals refer to their mechanical properties,physicochemical properties,electromagnetic properties,corrosion resistance,and the wettability and fluidity during brazing.The formability and processability of brazing filler metals include the processes of smelting and casting,extrusion,rolling,drawing and ring-making,as well as the processes of granulation,powder production,and the molding of amorphous and microcrystalline structures.The cost of brazing filler metals corresponds to the sum of materials value and manufacturing cost.Improving the comprehensive properties of brazing filler metals requires a comprehensive and systematic consideration of design indicators.Highlighting the unique characteristics of brazing filler metals should focus on relevant technical indicators.Binary or ternary eutectic structures can effectively enhance the flow spreading ability of brazing filler metals,and solid solution structures contribute to the formability.By employing the proposed design guidelines,typical Ag based,Cu based,Zn based brazing filler metals,and Sn based solders were designed and successfully applied in major scientific and engineering projects.展开更多
Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopi...Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.展开更多
OBJECTIVE:To assess the quality of Clinical practice guidelines(CPGs)in the context of diabetic kidney disease(DKD)and determine whether any factors affect the quality.METHODS:We searched eight databases along with fi...OBJECTIVE:To assess the quality of Clinical practice guidelines(CPGs)in the context of diabetic kidney disease(DKD)and determine whether any factors affect the quality.METHODS:We searched eight databases along with five international and national organizations to develop or archive guidelines from their inception to July 2023,with an additional search of medlive.cn.And the authoritative organizations related to nephrology.CPGs and consensus statements created using direct differential diagnosis or therapy for DKD were included without language restrictions.Their quality was evaluated by four reviewers using the Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ)instrument.Along with the item and domain scores,the guideline was also allocated an overall quality score,which ranged from 1(lowest possible quality)to 7(highest possible quality).Moreover,an overall recommendation for use was also assigned(“recommended”,“recommended with modifications”or“not recommended”).RESULTS:A total of 16 CPGs were included,of which 14 were from Asia and the remaining two from Europe.These two CPGs were updated in the third version.Six CPGs were recommended for use because their primary domains scored in the medium or high category.Furthermore,five CPGs were recommended with modifications as the stakeholder involvement,applicability,and editorial independence domains were evaluated as low categories.In all domains,the lowest average score was for rigour of development(33%),followed by application(36%),and stakeholder involvement(51%).The highest average score was for scope and purpose(79%),followed by clarity of presentation(75%).None of the CPGs considered the patient's viewpoint,and six of 16 CPGs did not use any grading system to translate the evidence into recommendations.Additionally,only three of 16 CPGs shared search strategy,and eight of 16 CPGs did not declare a funding source.CONCLUSIONS:According to the AGREE II evaluation,more than one in four CPGs for DKD had poor methodological quality.Enhanced efforts are needed to advance the rigour of development,application,and editorial independence of DKD guideline panels for most guidelines.Stakeholders,CPG developers,and CPG users should consider methodological quality while choosing CPGs,and interpret and implement their issued suggestions.展开更多
Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to ...Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.展开更多
Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with inc...Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with incidence and mortality rates continuing to rise(2).The Chinese Society of Clinical Oncology(CSCO)first introduced its guidelines in 2017,and since then,they have been updated annually to incorporate the latest clinical research findings,drug availability,and expert consensus(3-8).This article presents the key updates in the 2025 edition compared to the 2024 version.展开更多
Purpose:The aim was to synthesize quantitative and qualitative research that identified the most effective educational strategies for nurse-led inhaler technique(IT)education in Chronic Obstructive Pulmonary Disease(C...Purpose:The aim was to synthesize quantitative and qualitative research that identified the most effective educational strategies for nurse-led inhaler technique(IT)education in Chronic Obstructive Pulmonary Disease(COPD)patients,as perceived by patients,healthcare providers,and nurses.Methods:A systematic literature search in Embase,PubMed,Cochrane Library,Web of Science,and CINAHL from 2018 to 30 June 2024 was conducted.In total,327 articles were identified.The results of 14 studies that met the inclusion criteria were synthesized.Data were analyzed with des-criptive and semi-quantitative methods to yield summarizing findings on the effectiveness of different educational strate-gies.All investigations had assessed patient adherence to IT.Results:Data indicated that nurse-led IT teaching strategies are effective in promoting IT adherence and correctness in COPD patients utilizing the personalized Teach-Back method.However,studies in disease control and comparison of patient IT satisfaction and self-efficacy need further investigation.Conclusion:The results of this study may contribute to the understanding of the most effective educational strategies in nurse-led IT education for COPD patients.The synthesized findings can be used for the development of new educational interventions and assessment instruments for IT adherence.展开更多
1.Introduction Adherence to 24-hour movement guidelines—which encompass regular physical activity,adequate sleep,and limited sedentary time1—significantly influences long-term health outcomes during adolescence and ...1.Introduction Adherence to 24-hour movement guidelines—which encompass regular physical activity,adequate sleep,and limited sedentary time1—significantly influences long-term health outcomes during adolescence and contributes holistically to overall health.2 However,its prospective relationship with midlife mortality remains unknown to date.Our aim was to determine the association between adherence to 24-hour movement guidelines during adolescence and premature mortality 26-27 years later.This aim was based on existing evidence3 suggesting a potential link between meeting these guidelines and reduced mortality risk among adults in an 11-year follow-up.展开更多
Sham acupuncture,as a control intervention in acupuncture studies,has been widely conducted to eval-uate the specific effect of acupuncture.However,there was no relevant particular reporting guideline,so the reporting...Sham acupuncture,as a control intervention in acupuncture studies,has been widely conducted to eval-uate the specific effect of acupuncture.However,there was no relevant particular reporting guideline,so the reporting quality of sham acupuncture was low,which could hinder the precise understanding and interpretation of details and implementation background of sham acupuncture by researchers.In order to standardize the reporting of sham acupuncture and improve its quality,SHam Acupuncture REporting guidelines and a checklist in clinical trials(SHARE)was developed by a research team from Beijing Univer-sity of Chinese Medicine.The SAHRE standardizes the reporting of sham acupuncture from 10 categories,including brief name,rationales,details of sham acupuncture,treatment regimen of sham acupuncture,the information informed or explained to patients,practitioner information,modifications of protocol,communication between practitioner and patient,practitioner adherence and blinding.This article elab-orates the development process and key content of SHARE in order to facilitate its application by re-searchers.展开更多
The Interpretation of Nursing Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke offers comprehensive recommendations across five key domains:hospital organizational management,patient condition monitori...The Interpretation of Nursing Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke offers comprehensive recommendations across five key domains:hospital organizational management,patient condition monitoring,complication observation and management,positioning and mobility away from the bed,and quality assurance.These Guidelines encompass all the phases of intravenous thrombolysis care for patients experiencing acute ischemic stroke.This article aims to elucidate the Guidelines by discussing their developmental background,the designation process,usage recommendations,and the interpretation of evolving perspectives,thereby providing valuable insights for clinical practice.展开更多
In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided ...In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided additional options for improving patient outcomes.The 2024 Chinese Society of Clinical Oncology Guidelines for NSCLC(CSCO NSCLC),a key reference for clinical oncologists in China,have incorporated current global research and adapted recommendations for applicability in real-world scenarios in China.This update covers not only patient selection,efficacy,and safety,but also considers economics,and accessibility,with an aim to provide more precise and comprehensive treatment guidance for Chinese oncologists.展开更多
The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published s...The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.展开更多
Background:The Canadian 24-h movement guidelines(24-HMG)emphasize the holistic consideration of physical activity(PA),sedentary behavior,and sleep in shaping health outcomes.This study aimed to examine the association...Background:The Canadian 24-h movement guidelines(24-HMG)emphasize the holistic consideration of physical activity(PA),sedentary behavior,and sleep in shaping health outcomes.This study aimed to examine the associations between meeting 24-HMG and emotion regulation-related indicators among children and adolescents.Methods:A total of 534 Chinese children and adolescents aged 12.94±1.10 years(49.81%males)participated in this study and completed self-report measures assessing 24-h movement behaviors,emotion regulation strategies,emotion regulation flexibility,and regulatory emotional self-efficacy.Results:Only 7.12% of theparticipants adhered to two or all three guidelines.The number of guidelines met was positively associated with the use of emotion regulation strategies,emotion regulation flexibility,and regulatory emotional self-efficacy.Compared with meeting none of the guidelines,participants whomet one ormore guidelines reported significantly better performance in these outcomes.Conclusion:Meeting 24-HMG was associated with superior emotion regulation in children and adolescents.The importance of engaging in regular PA,limiting recreational screen time,and getting enough sleep should be highlighted for fostering emotion regulation in this demographic.展开更多
Glaucoma is an eye disease characterized by pathologically elevated intraocular pressure,optic nerve atrophy,and visual field defects,which can lead to irreversible vision loss.In recent years,the rapid development of...Glaucoma is an eye disease characterized by pathologically elevated intraocular pressure,optic nerve atrophy,and visual field defects,which can lead to irreversible vision loss.In recent years,the rapid development of artificial intelligence(AI)technology has provided new approaches for the early diagnosis and management of glaucoma.By classifying and annotating glaucoma-related images,AI models can learn and recognize the specific pathological features of glaucoma,thereby achieving automated imaging analysis and classification.Research on glaucoma imaging classification and annotation mainly involves color fundus photography(CFP),optical coherence tomography(OCT),anterior segment optical coherence tomography(AS-OCT),and ultrasound biomicroscopy(UBM)images.CFP is primarily used for the annotation of the optic cup and disc,while OCT is used for measuring and annotating the thickness of the retinal nerve fiber layer,and AS-OCT and UBM focus on the annotation of the anterior chamber angle structure and the measurement of anterior segment structural parameters.To standardize the classification and annotation of glaucoma images,enhance the quality and consistency of annotated data,and promote the clinical application of intelligent ophthalmology,this guideline has been developed.This guideline systematically elaborates on the principles,methods,processes,and quality control requirements for the classification and annotation of glaucoma images,providing standardized guidance for the classification and annotation of glaucoma images.展开更多
Objective:Pain management is an integral part of nursing practice.In this respect,angina management can be a serious clinical problem for nurses.The evaluation of pain management based on guidelines is one of the esse...Objective:Pain management is an integral part of nursing practice.In this respect,angina management can be a serious clinical problem for nurses.The evaluation of pain management based on guidelines is one of the essential components in quality assurance and improvement processes.One of the most necessary steps in this process to improve pain management is to analyze the existing situation.This study aimed to determine the compliance of critical care unit(CCU)nurses’care performance in angina management with evidence-based guidelines(EBGs).Methods:In this observational cross-sectional study,69 nurses working in the CCU departments of public hospitals in Bushehr province participated using the full number method,and their performance was observed 207 times.The data collection tool in this study included a demographic profile form and a 29-item checklist of nurses’performance in angina management.The performance of each nurse was evaluated three times in three different shifts.Descriptive and analytical independent t-tests and Spearman and Pearson correlation were used to analyze the data.SPSS 19 software was used to perform statistical tests.The significance level was considered to be<0.05 in all cases.Results:The findings showed that 85.5%of the participants were female and 14.5%were male,with an average age of 33.87±7.14 years.The average score for performing care functions according to the evidence-based pain management guidelines was 71.42±19.31.The highest(73.60±19.45)and lowest(63.51±28.27)average scores were related to the investigation and evaluation area,respectively.The results showed a significant negative correlation between age and care performance(p<0.03;r=−0.265).Conclusions:The results of this study showed that the average performance score of nurses in angina management based on the guidelines was higher than average.Considering that some items had little compliance,the health system planners are recommended to put the annual training methods to obtain and use the latest guidelines for pain management,especially angina,in the education program of nurses.展开更多
Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs wer...Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs were identified through literature searches across 3 international and 4 Chinese databases.Methodological quality was appraised using A MeaSurement Tool to Assess systematic Reviews 2.Logistic regressions were used to explore associations between bibliographical characteristics and quality.Results:Analyses of methodological quality found that among the 213 sampled SRs,69.5%were of critically low quality,30.5%were of low quality,and none achieved high or moderate quality.Common shortcomings included the failure to identify the studies excluded from the analysis,failure to disclose funding sources,and limited evaluation of the potential impact of bias on conclusions.Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions tended to be of lower quality than SRs led by authors affiliated with hospitals or clinical facilities.Conclusion:Recent Chinese language CHM SRs exhibited limited methodological quality,making them unlikely to support the development of clinical practice guidelines.Urgent initiatives are needed to enhance training for researchers,peer-reviewers and editors involved in the preparation and publication of SRs.Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines in Chinese language journals is crucial to improve the relevance of SRs for Chinese medicine development.Addressing deficiencies in methodology and reporting is essential for promoting evidence-based practices and informed clinical decisions in Chinese medicine.展开更多
The current epidemic of non-alcoholic fatty liver disease(NAFLD) is reshaping the field of hepatology all around the world.The widespread diffusion of metabolic risk factors such as obesity,type2-diabetes mellitus,and...The current epidemic of non-alcoholic fatty liver disease(NAFLD) is reshaping the field of hepatology all around the world.The widespread diffusion of metabolic risk factors such as obesity,type2-diabetes mellitus,and dyslipidemia has led to a worldwide diffusion of NAFLD.In parallel to the increased availability of effective anti-viral agents,NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries,and a similar trend is expected in Eastern Countries in the next years.This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis,management,and treatment of NAFLD.Different scientific societies from Europe,America,and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD.These guidelines are consistent with the key elements in the management of NAFLD,but still,show significant difference about some critical points.We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences.We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions.Differences were noted in: the definition of NAFLD,the opportunity of NAFLD screening in high-risk patients,the noninvasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis,in the follow-up protocols and,finally,in the treatment strategy(especially in the proposed pharmacological management).These difference have been discussed in the light of the possible evolution of the scenario ofNAFLD in the next years.展开更多
AIM To summarize and compare worldwide colorectal cancer(CRC) screening recommendations in order to identify similarities and disparities.METHODS A systematic literature search was performed using MEDLINE, EMBASE, Sco...AIM To summarize and compare worldwide colorectal cancer(CRC) screening recommendations in order to identify similarities and disparities.METHODS A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website,Google and Google Scholar was performed. RESULTS Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy(every 10 years), or flexible sigmoidoscopy(FS, every 5 years) or fecal occult blood test(FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening. CONCLUSION Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.展开更多
A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the ...A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines＇ Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association （AUA） and American Society for Reproductive Medicine （ASRM） did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology （EAU） and European Society of Pediatric Urology （ESPU） were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.展开更多
BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing countries.The widespread diffusion of gluten-containing di...BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing countries.The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence.This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media.However,in recent years,the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease(CD)from obscurity to global prominence.These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD.Different scientific societies,mainly from Europe and America,have proposed guidelines based on CD's most recent evidence.AIM To identify the most recent scientific guidelines on CD,aiming to find and critically analyse the main differences.METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language.PubMed was lastly accessed on 1 March 2021.RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions.Differences were noted in the possibility of a no-biopsy diagnosis,HLA testing,follow-up protocols,and procedures.CONCLUSION We found a relatively high concordance between the guidelines for CD.Important modifications have occurred in the last years,especially about the possibility of a no-biopsy diagnosis in children.Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.展开更多
文摘Objective:This study aimed to systematically evaluate the measurement characteristics and methodological quality of childbirth experience assessment tools,with a view to informing the selection of healthcare professionals who can provide high-quality assessment tools.Method:A systematic search was performed on specific databases:PubMed,Web of Science,Embase,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),and Wanfang,from inception to February 29,2024.The researchers retrieved studies on the measurement attributes of the childbirth experience assessment tool,and traced back the references of the included studies to supplement relevant literature.According to the inclusion and exclusion criteria,screening and data extraction were independently undertaken by two reviewers.Two researchers individually used the Consensus-based Standards for the Selection of Health Measurement Instruments(COSMIN)Risk of Bias Checklist to assess the methodological quality of the scale,applied the COSMIN criteria to evaluate the measurement properties of the scale,and used a modified Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system to assess the certainty of evidence.Result:A total of 15 studies were included to evaluate the psychometric properties of 11 childbirth experience assessment tools(including different language versions).Eight studies’methodological quality of content validity was doubtful,and the remaining studies did not report content validity.None of the tools reported measurement error,cross-cultural validity,or responsiveness.In light of the questionable or unreported content validity of the tools,the evidence quality was deemed moderate or below.Consequently,the 11 assessment tools were recommended as grade B.Conclusion:In contrast,the Questionnaire for Assessing the Childbirth Experience(QACE)is recommended for provisional use,given its relatively good methodological and measurement attributes and appropriate content for evaluation.However,further validation of other measurement properties is needed.
基金National Natural Science Foundation of China(U22A20191)。
文摘Brazing filler metals are widely applied,which serve as an industrial adhesive in the joining of dissimilar structures.With the continuous emergence of new structures and materials,the demand for novel brazing filler metals is ever-increasing.It is of great significance to investigate the optimized composition design methods and to establish systematic design guidelines for brazing filler metals.This study elucidated the fundamental rules for the composition design of brazing filler metals from a three-dimensional perspective encompassing the basic properties of applied brazing filler metals,formability and processability,and overall cost.The basic properties of brazing filler metals refer to their mechanical properties,physicochemical properties,electromagnetic properties,corrosion resistance,and the wettability and fluidity during brazing.The formability and processability of brazing filler metals include the processes of smelting and casting,extrusion,rolling,drawing and ring-making,as well as the processes of granulation,powder production,and the molding of amorphous and microcrystalline structures.The cost of brazing filler metals corresponds to the sum of materials value and manufacturing cost.Improving the comprehensive properties of brazing filler metals requires a comprehensive and systematic consideration of design indicators.Highlighting the unique characteristics of brazing filler metals should focus on relevant technical indicators.Binary or ternary eutectic structures can effectively enhance the flow spreading ability of brazing filler metals,and solid solution structures contribute to the formability.By employing the proposed design guidelines,typical Ag based,Cu based,Zn based brazing filler metals,and Sn based solders were designed and successfully applied in major scientific and engineering projects.
文摘Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.
文摘OBJECTIVE:To assess the quality of Clinical practice guidelines(CPGs)in the context of diabetic kidney disease(DKD)and determine whether any factors affect the quality.METHODS:We searched eight databases along with five international and national organizations to develop or archive guidelines from their inception to July 2023,with an additional search of medlive.cn.And the authoritative organizations related to nephrology.CPGs and consensus statements created using direct differential diagnosis or therapy for DKD were included without language restrictions.Their quality was evaluated by four reviewers using the Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ)instrument.Along with the item and domain scores,the guideline was also allocated an overall quality score,which ranged from 1(lowest possible quality)to 7(highest possible quality).Moreover,an overall recommendation for use was also assigned(“recommended”,“recommended with modifications”or“not recommended”).RESULTS:A total of 16 CPGs were included,of which 14 were from Asia and the remaining two from Europe.These two CPGs were updated in the third version.Six CPGs were recommended for use because their primary domains scored in the medium or high category.Furthermore,five CPGs were recommended with modifications as the stakeholder involvement,applicability,and editorial independence domains were evaluated as low categories.In all domains,the lowest average score was for rigour of development(33%),followed by application(36%),and stakeholder involvement(51%).The highest average score was for scope and purpose(79%),followed by clarity of presentation(75%).None of the CPGs considered the patient's viewpoint,and six of 16 CPGs did not use any grading system to translate the evidence into recommendations.Additionally,only three of 16 CPGs shared search strategy,and eight of 16 CPGs did not declare a funding source.CONCLUSIONS:According to the AGREE II evaluation,more than one in four CPGs for DKD had poor methodological quality.Enhanced efforts are needed to advance the rigour of development,application,and editorial independence of DKD guideline panels for most guidelines.Stakeholders,CPG developers,and CPG users should consider methodological quality while choosing CPGs,and interpret and implement their issued suggestions.
文摘Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.
基金supported by the National Natural Science Foundation of China(No.82373415)Beijing Xisike Clinical Oncology Research Foundation(No.Ytongshu2021/ms-0003)。
文摘Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with incidence and mortality rates continuing to rise(2).The Chinese Society of Clinical Oncology(CSCO)first introduced its guidelines in 2017,and since then,they have been updated annually to incorporate the latest clinical research findings,drug availability,and expert consensus(3-8).This article presents the key updates in the 2025 edition compared to the 2024 version.
文摘Purpose:The aim was to synthesize quantitative and qualitative research that identified the most effective educational strategies for nurse-led inhaler technique(IT)education in Chronic Obstructive Pulmonary Disease(COPD)patients,as perceived by patients,healthcare providers,and nurses.Methods:A systematic literature search in Embase,PubMed,Cochrane Library,Web of Science,and CINAHL from 2018 to 30 June 2024 was conducted.In total,327 articles were identified.The results of 14 studies that met the inclusion criteria were synthesized.Data were analyzed with des-criptive and semi-quantitative methods to yield summarizing findings on the effectiveness of different educational strate-gies.All investigations had assessed patient adherence to IT.Results:Data indicated that nurse-led IT teaching strategies are effective in promoting IT adherence and correctness in COPD patients utilizing the personalized Teach-Back method.However,studies in disease control and comparison of patient IT satisfaction and self-efficacy need further investigation.Conclusion:The results of this study may contribute to the understanding of the most effective educational strategies in nurse-led IT education for COPD patients.The synthesized findings can be used for the development of new educational interventions and assessment instruments for IT adherence.
文摘1.Introduction Adherence to 24-hour movement guidelines—which encompass regular physical activity,adequate sleep,and limited sedentary time1—significantly influences long-term health outcomes during adolescence and contributes holistically to overall health.2 However,its prospective relationship with midlife mortality remains unknown to date.Our aim was to determine the association between adherence to 24-hour movement guidelines during adolescence and premature mortality 26-27 years later.This aim was based on existing evidence3 suggesting a potential link between meeting these guidelines and reduced mortality risk among adults in an 11-year follow-up.
文摘Sham acupuncture,as a control intervention in acupuncture studies,has been widely conducted to eval-uate the specific effect of acupuncture.However,there was no relevant particular reporting guideline,so the reporting quality of sham acupuncture was low,which could hinder the precise understanding and interpretation of details and implementation background of sham acupuncture by researchers.In order to standardize the reporting of sham acupuncture and improve its quality,SHam Acupuncture REporting guidelines and a checklist in clinical trials(SHARE)was developed by a research team from Beijing Univer-sity of Chinese Medicine.The SAHRE standardizes the reporting of sham acupuncture from 10 categories,including brief name,rationales,details of sham acupuncture,treatment regimen of sham acupuncture,the information informed or explained to patients,practitioner information,modifications of protocol,communication between practitioner and patient,practitioner adherence and blinding.This article elab-orates the development process and key content of SHARE in order to facilitate its application by re-searchers.
文摘The Interpretation of Nursing Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke offers comprehensive recommendations across five key domains:hospital organizational management,patient condition monitoring,complication observation and management,positioning and mobility away from the bed,and quality assurance.These Guidelines encompass all the phases of intravenous thrombolysis care for patients experiencing acute ischemic stroke.This article aims to elucidate the Guidelines by discussing their developmental background,the designation process,usage recommendations,and the interpretation of evolving perspectives,thereby providing valuable insights for clinical practice.
基金supported by the Shanghai Excellent Academic Leader(Grant No.21XD1423200)。
文摘In the past year,several advancements have been achieved in the treatment of advanced non-small cell lung cancer(NSCLC),particularly in the areas of immunotherapy and targeted therapy.These achievements have provided additional options for improving patient outcomes.The 2024 Chinese Society of Clinical Oncology Guidelines for NSCLC(CSCO NSCLC),a key reference for clinical oncologists in China,have incorporated current global research and adapted recommendations for applicability in real-world scenarios in China.This update covers not only patient selection,efficacy,and safety,but also considers economics,and accessibility,with an aim to provide more precise and comprehensive treatment guidance for Chinese oncologists.
文摘The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.
基金supported by Zhejiang Provincial Social Science Funding(22NDJC050YB).
文摘Background:The Canadian 24-h movement guidelines(24-HMG)emphasize the holistic consideration of physical activity(PA),sedentary behavior,and sleep in shaping health outcomes.This study aimed to examine the associations between meeting 24-HMG and emotion regulation-related indicators among children and adolescents.Methods:A total of 534 Chinese children and adolescents aged 12.94±1.10 years(49.81%males)participated in this study and completed self-report measures assessing 24-h movement behaviors,emotion regulation strategies,emotion regulation flexibility,and regulatory emotional self-efficacy.Results:Only 7.12% of theparticipants adhered to two or all three guidelines.The number of guidelines met was positively associated with the use of emotion regulation strategies,emotion regulation flexibility,and regulatory emotional self-efficacy.Compared with meeting none of the guidelines,participants whomet one ormore guidelines reported significantly better performance in these outcomes.Conclusion:Meeting 24-HMG was associated with superior emotion regulation in children and adolescents.The importance of engaging in regular PA,limiting recreational screen time,and getting enough sleep should be highlighted for fostering emotion regulation in this demographic.
基金Supported by Guangdong Basic and Applied Basic Research Foundation(No.2025A1515011627)San Ming Project of Medicine in Shenzhen(No.SZSM202311012).
文摘Glaucoma is an eye disease characterized by pathologically elevated intraocular pressure,optic nerve atrophy,and visual field defects,which can lead to irreversible vision loss.In recent years,the rapid development of artificial intelligence(AI)technology has provided new approaches for the early diagnosis and management of glaucoma.By classifying and annotating glaucoma-related images,AI models can learn and recognize the specific pathological features of glaucoma,thereby achieving automated imaging analysis and classification.Research on glaucoma imaging classification and annotation mainly involves color fundus photography(CFP),optical coherence tomography(OCT),anterior segment optical coherence tomography(AS-OCT),and ultrasound biomicroscopy(UBM)images.CFP is primarily used for the annotation of the optic cup and disc,while OCT is used for measuring and annotating the thickness of the retinal nerve fiber layer,and AS-OCT and UBM focus on the annotation of the anterior chamber angle structure and the measurement of anterior segment structural parameters.To standardize the classification and annotation of glaucoma images,enhance the quality and consistency of annotated data,and promote the clinical application of intelligent ophthalmology,this guideline has been developed.This guideline systematically elaborates on the principles,methods,processes,and quality control requirements for the classification and annotation of glaucoma images,providing standardized guidance for the classification and annotation of glaucoma images.
文摘Objective:Pain management is an integral part of nursing practice.In this respect,angina management can be a serious clinical problem for nurses.The evaluation of pain management based on guidelines is one of the essential components in quality assurance and improvement processes.One of the most necessary steps in this process to improve pain management is to analyze the existing situation.This study aimed to determine the compliance of critical care unit(CCU)nurses’care performance in angina management with evidence-based guidelines(EBGs).Methods:In this observational cross-sectional study,69 nurses working in the CCU departments of public hospitals in Bushehr province participated using the full number method,and their performance was observed 207 times.The data collection tool in this study included a demographic profile form and a 29-item checklist of nurses’performance in angina management.The performance of each nurse was evaluated three times in three different shifts.Descriptive and analytical independent t-tests and Spearman and Pearson correlation were used to analyze the data.SPSS 19 software was used to perform statistical tests.The significance level was considered to be<0.05 in all cases.Results:The findings showed that 85.5%of the participants were female and 14.5%were male,with an average age of 33.87±7.14 years.The average score for performing care functions according to the evidence-based pain management guidelines was 71.42±19.31.The highest(73.60±19.45)and lowest(63.51±28.27)average scores were related to the investigation and evaluation area,respectively.The results showed a significant negative correlation between age and care performance(p<0.03;r=−0.265).Conclusions:The results of this study showed that the average performance score of nurses in angina management based on the guidelines was higher than average.Considering that some items had little compliance,the health system planners are recommended to put the annual training methods to obtain and use the latest guidelines for pain management,especially angina,in the education program of nurses.
基金supported by Chinese Medicine Development Fund of the Hong Kong SAR(No.21B2/018A)。
文摘Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs were identified through literature searches across 3 international and 4 Chinese databases.Methodological quality was appraised using A MeaSurement Tool to Assess systematic Reviews 2.Logistic regressions were used to explore associations between bibliographical characteristics and quality.Results:Analyses of methodological quality found that among the 213 sampled SRs,69.5%were of critically low quality,30.5%were of low quality,and none achieved high or moderate quality.Common shortcomings included the failure to identify the studies excluded from the analysis,failure to disclose funding sources,and limited evaluation of the potential impact of bias on conclusions.Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions tended to be of lower quality than SRs led by authors affiliated with hospitals or clinical facilities.Conclusion:Recent Chinese language CHM SRs exhibited limited methodological quality,making them unlikely to support the development of clinical practice guidelines.Urgent initiatives are needed to enhance training for researchers,peer-reviewers and editors involved in the preparation and publication of SRs.Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines in Chinese language journals is crucial to improve the relevance of SRs for Chinese medicine development.Addressing deficiencies in methodology and reporting is essential for promoting evidence-based practices and informed clinical decisions in Chinese medicine.
文摘The current epidemic of non-alcoholic fatty liver disease(NAFLD) is reshaping the field of hepatology all around the world.The widespread diffusion of metabolic risk factors such as obesity,type2-diabetes mellitus,and dyslipidemia has led to a worldwide diffusion of NAFLD.In parallel to the increased availability of effective anti-viral agents,NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries,and a similar trend is expected in Eastern Countries in the next years.This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis,management,and treatment of NAFLD.Different scientific societies from Europe,America,and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD.These guidelines are consistent with the key elements in the management of NAFLD,but still,show significant difference about some critical points.We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences.We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions.Differences were noted in: the definition of NAFLD,the opportunity of NAFLD screening in high-risk patients,the noninvasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis,in the follow-up protocols and,finally,in the treatment strategy(especially in the proposed pharmacological management).These difference have been discussed in the light of the possible evolution of the scenario ofNAFLD in the next years.
文摘AIM To summarize and compare worldwide colorectal cancer(CRC) screening recommendations in order to identify similarities and disparities.METHODS A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website,Google and Google Scholar was performed. RESULTS Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy(every 10 years), or flexible sigmoidoscopy(FS, every 5 years) or fecal occult blood test(FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening. CONCLUSION Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.
文摘A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines＇ Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association （AUA） and American Society for Reproductive Medicine （ASRM） did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology （EAU） and European Society of Pediatric Urology （ESPU） were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.
文摘BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing countries.The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence.This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media.However,in recent years,the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease(CD)from obscurity to global prominence.These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD.Different scientific societies,mainly from Europe and America,have proposed guidelines based on CD's most recent evidence.AIM To identify the most recent scientific guidelines on CD,aiming to find and critically analyse the main differences.METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language.PubMed was lastly accessed on 1 March 2021.RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions.Differences were noted in the possibility of a no-biopsy diagnosis,HLA testing,follow-up protocols,and procedures.CONCLUSION We found a relatively high concordance between the guidelines for CD.Important modifications have occurred in the last years,especially about the possibility of a no-biopsy diagnosis in children.Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.
