Background:Physical diagnosis is the first course of clinical medicine and the first contact with patients during clinical practice.Evidence-based physical diagnosis is a helpful tool in both education and practice.We...Background:Physical diagnosis is the first course of clinical medicine and the first contact with patients during clinical practice.Evidence-based physical diagnosis is a helpful tool in both education and practice.We aim to compare the accuracy of physical signs based on practice experience and research evidence.Methods:A questionnaire was designed and administered using convenience sampling to collect empirical estimates of physical signs.The literature search was conducted using Medline,EMBASE,and the Cochrane Library up to December 2023.Included studies independently compared diagnostic performance between physical signs and acceptable diagnostic standards.Hierarchical summary receiver operating characteristic models were used to summarize test accuracy data across studies.The pooled sensitivity,specificity,likelihood ratios,and diagnostic odds ratio were calculated.Results from the two parts were compared.Results:A total of 1971 respondents completed the questionnaire,and 37 studies reporting the performance of physical signs were included in the review.Compared with synthesized results of meta-analysis,estimations of palpable liver(sensitivity and specificity),palpable spleen(sensitivity and specificity),Traube space dullness(sensitivity and specificity),shifting dullness(sensitivity),right upper quadrant(RUQ)tenderness(sensitivity and specificity),Murphy sign(specificity),and distended abdomen(sensitivity)had relatively good concordance.The sensitivity of bulging flanks and the specificity of the distended abdomen were underestimated.The specificity of bulging flanks,shifting dullness,and sensitivity of the Murphy sign were overestimated.Conclusions:Variable results were observed in the comparison between clinical experience and evidence-based medicine.Evidence-based physical diagnosis should be introduced during teaching and emphasized throughout a career as a guide for accumulating expertise.展开更多
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s...Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.展开更多
Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all importan...Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.展开更多
Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a ...Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life(HRQoL).Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences.Hence,as mortality decreases within critical care,it becomes increasingly important to measure intensive care unit(ICU)survivor HRQoL.HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0(representing death)and 1(representing full health).They can be combined with survival to calculate quality-adjusted life-years(QALY),which are one of the most widely used methods of combining morbidity and mortality into a composite outcome.Although QALYs have been use for health-technology assessment decision-making,an emerging and novel role would be to inform clinical decision-making for patients,families and healthcare providers about what expected HRQoL may be during and after ICU care.Critical care randomized control trials(RCTs)have not routinely measured or reported HRQoL(until more recently),likely due to incapacity of some patients to participate in patient-reported outcome measures.Further differences in HRQoL measurement tools can lead to non-comparable values.To this end,we propose the validation of a gold-standard HRQoL tool in critical care,specifically the EQ-5D-5L.Both combined health-utility and mortality(disaggregated)and QALYs(aggregated)can be reported,with disaggregation allowing for determination of which components are the main drivers of the QALY outcome.Increased use of HRQoL,health-utility,and QALYs in critical care RCTs has the potential to:(1)Increase the likelihood of finding important effects if they exist;(2)improve research efficiency;and(3)help inform optimal management of critically ill patients allowing for decision-making about their HRQoL,in additional to traditional health-technology assessments.展开更多
Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in de...Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.展开更多
Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplan...Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.展开更多
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stres...The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stress can be the driving factor that promote the onset of depression.Both stress and depression,if not resolved over time,activate the production of transcription factors that will switch on pro-inflammatory genes and translate them into cytokines.This cascade fosters systemic chronic inflammation and reduced plasma BDNF levels.Since people with depression have a 60%increased risk of developing type 2diabetes(T2D)and show high levels of inflammation and low levels of BDNF,we hypothesize possible reasons that might explain why T2D,depression and dementia are often associated in the same patient.展开更多
Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal ...Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.展开更多
Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as wel...Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.展开更多
Purpose: Medication compliance for chronic medications has been well studied, but there is a gap in the literature regarding compliance within the perioperative period. Our objective was to determine the incidence of ...Purpose: Medication compliance for chronic medications has been well studied, but there is a gap in the literature regarding compliance within the perioperative period. Our objective was to determine the incidence of patient non-compliance with preoperative medication instructions for adult non-emergent surgery. Additional objectives were to identify predictors of compliance, describe medication instructions by drug type, and explore the impact of non-compliance. Patients and Methods: This historical chart review evaluated preoperative compliance to medication instructions in 393 adults undergoing non-emergent surgeries at Hamilton Health Sciences between May 1, 2012, and April 30, 2013. Seven patient factors (age;sex;American Society of Anesthesiologists class;number of medications;type of surgery;time between preoperative appointment to surgery;the individual collecting the medication list) were evaluated as potential predictors of non-compliance and analyzed using logistic regression analysis. Consequences of non-compliance were assessed by impact on intraoperative blood pressure, blood glucose level, drop in hemoglobin, bronchospasm, and case delays. Results: One hundred forty-six (37.2%) patients were non-compliant with one or more medication reconciliation instructions provided by the anesthesiologist. No significant associations were observed for any patient risk factors and non-compliance. Non-compliance was not associated with any clinically significant consequences. Conclusions: Our study shows that 37.15% of adult patients undergoing non-emergent surgery were non-compliant with medication instructions, although patients did not receive any written instructions for 46% of their medications. We did not identify any predictive patient factors or adverse outcomes associated with non-compliance.展开更多
The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnos...The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.展开更多
To compare and characterize hypertriglyceridemia-induced acute pancreatitis(HTG-AP)across the geographical regions,we conducted a systematic review and a multi-center cohort study.We conducted a systematic review and ...To compare and characterize hypertriglyceridemia-induced acute pancreatitis(HTG-AP)across the geographical regions,we conducted a systematic review and a multi-center cohort study.We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP.Also,we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China.The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression.Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants(35%female,median age 50 years).The pooled proportion of HTG-AP was 11.6%globally while the Eastern and Western countries reported the proportions as 16.3%and 5.4%,respectively(P<0.01).The pooled mortality rate was remarkably higher in Eastern countries(4.1%)than in Western countries(1.0%)(P<0.01).3,224 participants(37%female,median age 48 years)were included in our multi-center cohort study,and the proportion of HTG-AP was much higher at 35.9%with a nearly three-fold higher mortality rate compared with acute pancreatitis(AP)due to other etiologies(odds ratio(OR):2.77,95%confidence interval(CI):1.60 to 4.81).The proportion of patients with HTG-AP is remarkably higher in Eastern countries,particularly China,than in Western countries.Furthermore,compared with other causes of AP,HTG-AP has a poorer prognosis and may warrant aggressive management.展开更多
Background:Conducting a systematic review(SR)is a time-intensive process and represents the first phase in developing a clinical practice guideline(CPG).Completing a CPG through the Program in Evidence-Based Care(PEBC...Background:Conducting a systematic review(SR)is a time-intensive process and represents the first phase in developing a clinical practice guideline(CPG).Completing a CPG through the Program in Evidence-Based Care(PEBC),a globally acknowledged guideline program supported by Ontario Health(Cancer Care Ontario),typically takes about 2 years.Thus,expediting an SR can significantly reduce the overall time required to complete a CPG.Our recently published review identified two artificial intelligence(AI)tools,DistillerSR and EPPI-Reviewer that reduced time in the title and abstract screening in an SR process when developing a CPG.However,the consistency and generalizability of these tools remain unclear within or across different SRs related to cancer.This study protocol aims to evaluate and compare the performance of DistillerSR and EPPI-Reviewer against human reviewers for title and abstract screening(Stage I screening)in cancer CPG development.Methods:We will conduct a retrospective simulation study to evaluate and compare the performance of DistillerSR and EPPI-Reviewer across 10 previously published CPGs by PEBC.These CPGs include the five cancer types with the highest incidence(lung,breast,prostate,colorectal,and bladder).We will run 30 simulation trials for one CPG per AI tool.Primary outcomes are workload savings and time savings in Stage I screening.The secondary outcome is the percentage of missing articles among the final included articles.This informs the accuracy and comprehensiveness of the AI tools.Descriptive and inferential statistical analysis will be conducted to evaluate the outcomes.Results:This is a study protocol.The data presented in the tables are illustrative examples rather than actual study results,in accordance with the journal’s standard structure.All data included in the final study will be thoroughly validated.Discussion:This will be the first study to investigate and compare the performance of DistillerSR and EPPI-Reviewer in Stage I screening of SRs in CPGs across different cancer types.These findings will inform the reliable use of AI tools in future cancer-related CPGs.The results from this retrospective study will need to be confirmed by prospective studies.展开更多
Promoting the international acceptance of clinical studies about traditional Chinese medicine(TCM)interventions is a key strategy for internationalization of TCM.However,the complexities of TCM interventions—in terms...Promoting the international acceptance of clinical studies about traditional Chinese medicine(TCM)interventions is a key strategy for internationalization of TCM.However,the complexities of TCM interventions—in terms of the theories,practice patterns,and components—pose challenges to the design and implementation of clinical studies that are well accepted by the international community.This article summarized the current status of clinical studies about TCM interventions that were published in international journals,explored underlying barriers hindering the international acceptance,and discussed potential strategies for future development.展开更多
This document is about heart failure(HF),including acute and chronic heart failure,heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies.Context-sp...This document is about heart failure(HF),including acute and chronic heart failure,heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies.Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks,benefits,and overall value of each therapy,aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population.These guidelines provide evidence-based recommendations that represent a group consensus considering many other published guidelines that have reviewed many of the issues discussed here,but they also make new recommendations where new evidence has recently emerged.Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients.Such"economic adjustment"recommendations aim to provide guidance for situations when"Resources are somewhat limited"or when"Resources are severely limited".Hence,this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological,non-pharmacological,invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.展开更多
Background The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized.This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the ...Background The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized.This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population.Methods We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses.Trial registries,reference lists of included studies,and preprint servers were hand-searched for relevant studies.Random-effects meta-analyses were conducted to pool odds ratios for each risk factor.Individual study risk of bias was rated using QUIPS,and the GRADE framework was used to assess the certainty of evidence for each unique factor.Results Sixteen observational studies(N=46,262)were included,and 19 risk factors were amenable to meta-analysis.With moderate certainty in the evidence,age(per 2-year increase),allergic rhinitis,obesity,previous respiratory diseases,hospitalization,severe acute COVID-19,and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID.Female sex,asthma,comorbidity,and heart diseases may be associated with an increased risk of long COVID,and Asian and Black races may be associated with a decreased risk of long COVID.We did not observe any credible subgroup effects for any risk factor.Conclusions The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population.Further research is necessary to elucidate the pathophysiology of long COVID.展开更多
Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting result...Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting results.Objective:To identify factors and their impact on the treatment effect of acupuncture in different outcomes.Methods:Acupuncture RCTs were searched from 7 databases including Medline(Pub Med),Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,VIP Database,and China Biology Medicine disc between January 1st,2015 and December 31st,2019.Eligible studies must compare acupuncture to no acupuncture,sham acupuncture,or waiting lists,and report at least 1patient-important outcome.A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables,even those excluded from the multivariable model due to collinearities.We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences(SMDs),categorising them as small(<0.2),moderate(0.2–0.4),or large(>0.4) effects.Results:The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables.High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude,the difference of adjusted SMDs 0.46,95% confidence interval(CI) 0.07 to 0.84;P=0.02].The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables.Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture(0.30,95% CI 0.06 to 0.53;P=0.01).The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables.Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects,compared to non-penetrating acupuncture and fixed regimen,respectively(0.40,95% CI 0 to 0.80;P=0.05;0.29,95% CI 0.06 to 0.53;P=0.01).Conclusions:High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms.Penetrating acupuncture demonstrated greater effect in relieving nonpainful symptoms.Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes.Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.展开更多
A systematic review synthesizes evidence addressing a structured clinical question using systematic and explicit methods to search,identify,screen,critically appraise,and extract and analyze data from relevant studies...A systematic review synthesizes evidence addressing a structured clinical question using systematic and explicit methods to search,identify,screen,critically appraise,and extract and analyze data from relevant studies.[1]A meta-analysis,on the other hand,is a statistical method that combines the quantitative results of available primary studies addressing the same question to generate a pooled summary estimate and confidence interval(CI).[2]Meta-analyses can increase statistical power,enhance precision,and answer questions that single trials are underpowered to address.Although there are systematic reviews where meta-analyses are not appropriate,when they are well-conducted and reported,systematic reviews combined with meta-analyses provide valuable information for clinicians,researchers,and policymakers.展开更多
基金supported by the National Natural Science Foundation of China(32170788)the National High Level Hospital Clinical Research Funding(2022-PUMCH-B-023)+2 种基金the Beijing Natural Science Foundation(7232123)the Beijing Natural Science Foundation(L232016)funding from Peking Union Medical College(2023zlgc0501).
文摘Background:Physical diagnosis is the first course of clinical medicine and the first contact with patients during clinical practice.Evidence-based physical diagnosis is a helpful tool in both education and practice.We aim to compare the accuracy of physical signs based on practice experience and research evidence.Methods:A questionnaire was designed and administered using convenience sampling to collect empirical estimates of physical signs.The literature search was conducted using Medline,EMBASE,and the Cochrane Library up to December 2023.Included studies independently compared diagnostic performance between physical signs and acceptable diagnostic standards.Hierarchical summary receiver operating characteristic models were used to summarize test accuracy data across studies.The pooled sensitivity,specificity,likelihood ratios,and diagnostic odds ratio were calculated.Results from the two parts were compared.Results:A total of 1971 respondents completed the questionnaire,and 37 studies reporting the performance of physical signs were included in the review.Compared with synthesized results of meta-analysis,estimations of palpable liver(sensitivity and specificity),palpable spleen(sensitivity and specificity),Traube space dullness(sensitivity and specificity),shifting dullness(sensitivity),right upper quadrant(RUQ)tenderness(sensitivity and specificity),Murphy sign(specificity),and distended abdomen(sensitivity)had relatively good concordance.The sensitivity of bulging flanks and the specificity of the distended abdomen were underestimated.The specificity of bulging flanks,shifting dullness,and sensitivity of the Murphy sign were overestimated.Conclusions:Variable results were observed in the comparison between clinical experience and evidence-based medicine.Evidence-based physical diagnosis should be introduced during teaching and emphasized throughout a career as a guide for accumulating expertise.
基金supported by the National Natural Science Foundation of China(No.82474644)the National Key R&D Foundation of China(No.2017YFC1703600)+1 种基金the Shenzhen“Sanming Project”(No.202101007)the Shenzhen Science and Technology Program(No.JCYJ2022081810080300)。
文摘Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.
基金This work was supported by the second batch of"Ten thousand plan"-National high-level talents special support plan(No.W02020052)National Natural Science Foundation of China(No.82072247,82204937)+1 种基金Natural Science Foundation of Beijing(No.L222150)the China Scholarship Council(No.202206557005)。
文摘Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
基金Supported by the EuroQol Research Foundation,No. 299-RA
文摘Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life(HRQoL).Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences.Hence,as mortality decreases within critical care,it becomes increasingly important to measure intensive care unit(ICU)survivor HRQoL.HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0(representing death)and 1(representing full health).They can be combined with survival to calculate quality-adjusted life-years(QALY),which are one of the most widely used methods of combining morbidity and mortality into a composite outcome.Although QALYs have been use for health-technology assessment decision-making,an emerging and novel role would be to inform clinical decision-making for patients,families and healthcare providers about what expected HRQoL may be during and after ICU care.Critical care randomized control trials(RCTs)have not routinely measured or reported HRQoL(until more recently),likely due to incapacity of some patients to participate in patient-reported outcome measures.Further differences in HRQoL measurement tools can lead to non-comparable values.To this end,we propose the validation of a gold-standard HRQoL tool in critical care,specifically the EQ-5D-5L.Both combined health-utility and mortality(disaggregated)and QALYs(aggregated)can be reported,with disaggregation allowing for determination of which components are the main drivers of the QALY outcome.Increased use of HRQoL,health-utility,and QALYs in critical care RCTs has the potential to:(1)Increase the likelihood of finding important effects if they exist;(2)improve research efficiency;and(3)help inform optimal management of critically ill patients allowing for decision-making about their HRQoL,in additional to traditional health-technology assessments.
文摘Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.
文摘Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stress can be the driving factor that promote the onset of depression.Both stress and depression,if not resolved over time,activate the production of transcription factors that will switch on pro-inflammatory genes and translate them into cytokines.This cascade fosters systemic chronic inflammation and reduced plasma BDNF levels.Since people with depression have a 60%increased risk of developing type 2diabetes(T2D)and show high levels of inflammation and low levels of BDNF,we hypothesize possible reasons that might explain why T2D,depression and dementia are often associated in the same patient.
文摘Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.
文摘Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.
文摘Purpose: Medication compliance for chronic medications has been well studied, but there is a gap in the literature regarding compliance within the perioperative period. Our objective was to determine the incidence of patient non-compliance with preoperative medication instructions for adult non-emergent surgery. Additional objectives were to identify predictors of compliance, describe medication instructions by drug type, and explore the impact of non-compliance. Patients and Methods: This historical chart review evaluated preoperative compliance to medication instructions in 393 adults undergoing non-emergent surgeries at Hamilton Health Sciences between May 1, 2012, and April 30, 2013. Seven patient factors (age;sex;American Society of Anesthesiologists class;number of medications;type of surgery;time between preoperative appointment to surgery;the individual collecting the medication list) were evaluated as potential predictors of non-compliance and analyzed using logistic regression analysis. Consequences of non-compliance were assessed by impact on intraoperative blood pressure, blood glucose level, drop in hemoglobin, bronchospasm, and case delays. Results: One hundred forty-six (37.2%) patients were non-compliant with one or more medication reconciliation instructions provided by the anesthesiologist. No significant associations were observed for any patient risk factors and non-compliance. Non-compliance was not associated with any clinically significant consequences. Conclusions: Our study shows that 37.15% of adult patients undergoing non-emergent surgery were non-compliant with medication instructions, although patients did not receive any written instructions for 46% of their medications. We did not identify any predictive patient factors or adverse outcomes associated with non-compliance.
基金supported(in part)by the National Key Research and Development Program of China(2020YFC0845500)the Special Project for Emergency of Hubei Province(2020FCA008)the First Level Funding of the Second Medical Leading Talent Project in Hubei Province。
文摘The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
基金supported by the National Key Research and Development Program of China(2024YFA0918504)Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2024-RW320-01)+2 种基金the National Natural Science Foundation of China(32170788,82460135)Beijing Natural Science Foundation(7232123,7244390,L248074)the National High Level Hospital Clinical Research Funding(2022-PUMCH-B-023).
文摘To compare and characterize hypertriglyceridemia-induced acute pancreatitis(HTG-AP)across the geographical regions,we conducted a systematic review and a multi-center cohort study.We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP.Also,we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China.The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression.Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants(35%female,median age 50 years).The pooled proportion of HTG-AP was 11.6%globally while the Eastern and Western countries reported the proportions as 16.3%and 5.4%,respectively(P<0.01).The pooled mortality rate was remarkably higher in Eastern countries(4.1%)than in Western countries(1.0%)(P<0.01).3,224 participants(37%female,median age 48 years)were included in our multi-center cohort study,and the proportion of HTG-AP was much higher at 35.9%with a nearly three-fold higher mortality rate compared with acute pancreatitis(AP)due to other etiologies(odds ratio(OR):2.77,95%confidence interval(CI):1.60 to 4.81).The proportion of patients with HTG-AP is remarkably higher in Eastern countries,particularly China,than in Western countries.Furthermore,compared with other causes of AP,HTG-AP has a poorer prognosis and may warrant aggressive management.
基金supported by the Hamilton Health Sciences Foundation(RD-241).
文摘Background:Conducting a systematic review(SR)is a time-intensive process and represents the first phase in developing a clinical practice guideline(CPG).Completing a CPG through the Program in Evidence-Based Care(PEBC),a globally acknowledged guideline program supported by Ontario Health(Cancer Care Ontario),typically takes about 2 years.Thus,expediting an SR can significantly reduce the overall time required to complete a CPG.Our recently published review identified two artificial intelligence(AI)tools,DistillerSR and EPPI-Reviewer that reduced time in the title and abstract screening in an SR process when developing a CPG.However,the consistency and generalizability of these tools remain unclear within or across different SRs related to cancer.This study protocol aims to evaluate and compare the performance of DistillerSR and EPPI-Reviewer against human reviewers for title and abstract screening(Stage I screening)in cancer CPG development.Methods:We will conduct a retrospective simulation study to evaluate and compare the performance of DistillerSR and EPPI-Reviewer across 10 previously published CPGs by PEBC.These CPGs include the five cancer types with the highest incidence(lung,breast,prostate,colorectal,and bladder).We will run 30 simulation trials for one CPG per AI tool.Primary outcomes are workload savings and time savings in Stage I screening.The secondary outcome is the percentage of missing articles among the final included articles.This informs the accuracy and comprehensiveness of the AI tools.Descriptive and inferential statistical analysis will be conducted to evaluate the outcomes.Results:This is a study protocol.The data presented in the tables are illustrative examples rather than actual study results,in accordance with the journal’s standard structure.All data included in the final study will be thoroughly validated.Discussion:This will be the first study to investigate and compare the performance of DistillerSR and EPPI-Reviewer in Stage I screening of SRs in CPGs across different cancer types.These findings will inform the reliable use of AI tools in future cancer-related CPGs.The results from this retrospective study will need to be confirmed by prospective studies.
基金supported by National Key R&D Program of China(Grant No.2023YFC3503304)National Science Fund for Distinguished Young Scholars(Grant No.82225049)+1 种基金Fundamental Research Funds for the Central Public Welfare Research Institutes(Grant No.2020YJSZX-3)1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(Grant No.ZYGD23004).
文摘Promoting the international acceptance of clinical studies about traditional Chinese medicine(TCM)interventions is a key strategy for internationalization of TCM.However,the complexities of TCM interventions—in terms of the theories,practice patterns,and components—pose challenges to the design and implementation of clinical studies that are well accepted by the international community.This article summarized the current status of clinical studies about TCM interventions that were published in international journals,explored underlying barriers hindering the international acceptance,and discussed potential strategies for future development.
文摘This document is about heart failure(HF),including acute and chronic heart failure,heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies.Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks,benefits,and overall value of each therapy,aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population.These guidelines provide evidence-based recommendations that represent a group consensus considering many other published guidelines that have reviewed many of the issues discussed here,but they also make new recommendations where new evidence has recently emerged.Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients.Such"economic adjustment"recommendations aim to provide guidance for situations when"Resources are somewhat limited"or when"Resources are severely limited".Hence,this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological,non-pharmacological,invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.
文摘Background The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized.This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population.Methods We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses.Trial registries,reference lists of included studies,and preprint servers were hand-searched for relevant studies.Random-effects meta-analyses were conducted to pool odds ratios for each risk factor.Individual study risk of bias was rated using QUIPS,and the GRADE framework was used to assess the certainty of evidence for each unique factor.Results Sixteen observational studies(N=46,262)were included,and 19 risk factors were amenable to meta-analysis.With moderate certainty in the evidence,age(per 2-year increase),allergic rhinitis,obesity,previous respiratory diseases,hospitalization,severe acute COVID-19,and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID.Female sex,asthma,comorbidity,and heart diseases may be associated with an increased risk of long COVID,and Asian and Black races may be associated with a decreased risk of long COVID.We did not observe any credible subgroup effects for any risk factor.Conclusions The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population.Further research is necessary to elucidate the pathophysiology of long COVID.
基金Supported by the National Natural Science Foundation of China (No.81973968)the China Academy of Chinese Medical Sciences (No.CI2021A03503, GH201901, and 2020YJSZX-1)。
文摘Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting results.Objective:To identify factors and their impact on the treatment effect of acupuncture in different outcomes.Methods:Acupuncture RCTs were searched from 7 databases including Medline(Pub Med),Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,VIP Database,and China Biology Medicine disc between January 1st,2015 and December 31st,2019.Eligible studies must compare acupuncture to no acupuncture,sham acupuncture,or waiting lists,and report at least 1patient-important outcome.A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables,even those excluded from the multivariable model due to collinearities.We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences(SMDs),categorising them as small(<0.2),moderate(0.2–0.4),or large(>0.4) effects.Results:The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables.High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude,the difference of adjusted SMDs 0.46,95% confidence interval(CI) 0.07 to 0.84;P=0.02].The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables.Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture(0.30,95% CI 0.06 to 0.53;P=0.01).The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables.Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects,compared to non-penetrating acupuncture and fixed regimen,respectively(0.40,95% CI 0 to 0.80;P=0.05;0.29,95% CI 0.06 to 0.53;P=0.01).Conclusions:High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms.Penetrating acupuncture demonstrated greater effect in relieving nonpainful symptoms.Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes.Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.
文摘A systematic review synthesizes evidence addressing a structured clinical question using systematic and explicit methods to search,identify,screen,critically appraise,and extract and analyze data from relevant studies.[1]A meta-analysis,on the other hand,is a statistical method that combines the quantitative results of available primary studies addressing the same question to generate a pooled summary estimate and confidence interval(CI).[2]Meta-analyses can increase statistical power,enhance precision,and answer questions that single trials are underpowered to address.Although there are systematic reviews where meta-analyses are not appropriate,when they are well-conducted and reported,systematic reviews combined with meta-analyses provide valuable information for clinicians,researchers,and policymakers.
