When prioritizing clinical questions in the development of the clinical practice guidelines, clinical questions with high recognition and low variability, or high score and less disagreement among experts were often prioritized, while questions with high recognition but high variability were excluded. By this approach, clinical questions with practical value but also showed high variability due to different causes were not accepted as priorities. There were some methodological and clinical limitations by doing so. By summarizing the causes and connotations of expert opinion variability in terms of clinical experience, expertise and values, this paper analyzed the advantages of the variability quantification application, and proposed corresponding methodological recommendations, so as to provide references for guideline developers in the priority selection of clinical questions.
In November 2017, the American Heart Association updated the pediatric basic life support and cardiopulmonary resuscitation (CPR) quality. The new guidelines focused on the clinical value of chest compression-only CPR versus CPR using chest compressions with rescue breaths in children, rather than a comprehensive revision of the 2015 edition guidelines. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated part content of the guidelines according to the continuous evidence review process. Guidelines recommend CPR using chest compressions with rescue breaths should be provided for infants and children with cardiac arrest. Bystanders provide chest compressions if they are unwilling or unable to deliver rescue breaths. This article mainly interprets the updated content.
The Essential of ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction was introduced, including epidemology, initial management in the emergency department and hospital management.
With the popularization of digestive endoscopy in children, colonoscopy has been widely used. As the basis of digestive endoscopy, bowel preparation directly affects the diagnosis and treatment results of colonoscopy. Compared with adults, the functioning of important organs of children is immature, and their ability of cognition, communication and tolerance are weak. Their structure of the digestive tract is also significantly different in different ages. However, there have been no existing evidence-based guidelines on bowel preparation for digestive endoscopy of Chinese children. Therefore, it is important to develop evidence-based guidelines for bowel preparation combined with the clinical practice in China. In order to provide guidance and decision-making basis for Chinese pediatricians, we collaborated with multidisciplinary experts, based on existing evidence, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, followed the Reporting Items for Practice Guidelines in Healthcare (RIGHT) to develop this guideline for bowel preparation related to the diagnosis and treatment of children's digestive endoscopy.
The UK's National Institute for Health and Care Excellence (NICE) published guideline of mental wellbeing at work on March 2, 2022. The guideline covers how to create the right conditions for mental wellbeing in the workplace, with the aim of promoting supportive and inclusive workplace environments and helping people with or at potential risk of mental health problems. This review will interpret the guidelines in detail.
Foreign body in the digestive tract is one of the common critical diseases in the gastroenterology department, and it is the most common in children. Due to the wide variety of foreign body ingestion, the treatment methods are diverse, and the potential risks and complications are constantly escalating. If the treatment is not timely or improper, serious consequences will occur. However, there are no guidelines for foreign bodies in the digestive tract for children in China. Therefore, the development of evidence-based guidelines for the management of foreign bodies in the digestive tract of children, based on clinical practice in China, is of great significance in effectively guiding and promoting the management of foreign bodies in the digestive tract of children. In order to provide guidance and decision-making basis for clinicians at all levels who treat children with foreign bodies in the digestive tract, we complied with standard development process, collaborated with multidisciplinary expertise, based on available evidence, combined with clinical practice, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, and followed the reporting items for practice guidelines in healthcare (RIGHT) to develop this guideline for the management of foreign bodies in the digestive tract of children.
Every country has its own clinical guideline to standardize medical care, and China is developing guidehnes too. Viewing the guidehne＇s usage in the world over many years, we find that it hasn＇t achieved good effect. The development of evidence-based medicine brings a primal change to guideline development. The evidence-based clinical guidehnes are arising in the world. We summarized the principle of developing evidence-based guideline according to the experience of Scotland to provide reference for domestic peers.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
To improve proper application of evidence in clinical practice．six relevant problems were reviewed．The problems included：① How to evaluate and use evidence from systenaatic reviews of randomized controlled trials?② How to evaluate and use evidence from randomized controlled trials?③ How to evaluate and use evidence from non—randomized controled trials?④ How to evaluate and use evidence from case series?⑤ How to evaluate and use expert opinions?⑥ How to evaluate and use chnical practice guidelines?