Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
Glycogen storage disease type Ib (GSD Ib) is a rare disorder of glycogen metabolism, often complicated by neutropenia/neutrophil dysfunction, leading to recurrent infections and the development of inflammatory bowel disease (IBD), which severely impacts patients’ quality of life. Empagliflozin, an SGLT2 inhibitor, has demonstrated the ability to restore neutrophil counts and function, thereby improving the immunodeficiency state in GSD Ib patients. This consensus aims to provide clinical practice recommendations for the use of empagliflozin in GSD Ib based on current evidence and expert experience. The purpose of this document is to outline these key points and offer guidance for the clinical application of empagliflozin in GSD Ib.
Chronic kidney disease (CKD) has become an important public health problem that seriously affects the physical and mental health of Chinese people. Nutritional therapy has become one of the important treatments for CKD. Domestic and international guidelines for CKD clinical nutrition therapy have been introduced, and the intake of various nutrients in CKD patients, especially protein intake, has been guided. In recent years, with the continuous development of nutrition assessment and treatment, the content of the guidelines has gradually improved, but some views are still controversial. This article explains the relevant guidelines for the treatment of CKD at home and abroad to provide reference for the clinical nutritional treatment of CKD patients.
Based on the site visit on the current application and practice of evidence-based medicine in USA, we find the difference between China and USA so as to further promote and plan the development of evidence-based medicine in China.
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.
Objective To evaluate quality and current status of traditional Chinese medicine (TCM) guidelines and consensus, and to promote the improvements in the quality of guidelines and consensus. Methods A systematic collection of TCM guidelines and consensus published in medical journals in 2022 was conducted. We used scientific, transparent, and applicable ranking tools (STAR) for evaluation, analyzed the scoring rates (%), and assessed the quality level and influencing factors of guidelines and consensus through methods such as comparison and stratification. Results A total of 130 TCM guidelines and consensus were included. Guideline areas with higher scores included recommendations (65.3%), evidence (55.9%), and guideline development groups (54.2%). In the case of consensus, higher scores were observed in recommendations (38.7%), guideline development groups (37.0%), and funding (30.0%). The total score rate of TCM guidelines exceeded that of national guidelines, while the consensus rate was lower. Stratified analysis revealed statistical differences in guideline score rates among journals and issuing institutions, as well as significant differences in consensus score rates among journals, formulation institutions, subjects, and funding categories. Conclusion The quantity and quality of TCM guidelines and consensus are on a positive trajectory, with higher quality levels in guidelines than in consensus. The overall quality of TCM guidelines surpasses that of national guidelines, particularly emphasizing the scientificity of guideline formulation. However, the overall quality of consensus remains lower than that of the national consensus. Factors such as journals, formulation institutions, subjects, and funding categories are identified as potential influences on the quality of TCM guidelines and consensus.
For the purposes of promoting the effect of secondary prevention of myocardial infarction, and improving the compliance with myocardial infarction (MI) secondary prevention, a guideline for strengthening patients self-management on non-pharmacological secondary prevention was produced by an multidiscipline team leaded by Chinese Association of Integrative Medicine clinical cardiovascular branch, Lanzhou University Evidence-Based Medicine Center, Peking University School of Nursing, Tianjin University of Traditional Chinese Medicine and Beijing University of Chinese Medicine. This is the first version of patient guideline in China. This paper introduces the main methods, processes and characteristics of the patient guideline development. It will provide reference to future researchers to the development of the patient guideline.
ObjectiveTo review guidelines on diet intervention for hypertension, compare the similarities/differences and the regularity of the guidelines, discuss the prevention and treatment effects of diet intervention for hypertension, promote the understanding of the guide, and to explore the best method of diet intervention for hypertension. MethodsDatabase such as CNKI, EMbase, PubMed, etc., as well as guideline websites were searched from inception to February 28th, 2014, for collecting guidelines on diet intervention in the prevention and treatment of hypertension. The Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) were applied to assess methodological quality of the guidelines. Characteristics of diets recommended by the guidelines were analyzed through comparing the different regions and quality levels of the guidelines. ResultsA total of 27 guidelines on diet intervention for hypertension were included. They were formulated by 5 continents, 9 countries, 2 regions (Taiwan of China and Europe), and 1 international organization (WHO). According to the AGREE Ⅱ instrument, 13 guidelines were graded as Level A (recommendation) and 14 were graded as Level B (recommended after changes), respectively. The domains were more than 60% except for "rigor of development" (57.89±7.71)% and "applicability" (58.39±6.29)%. Each guideline recommended low sodium diet (usually:5 to 6 g/d; Oceania:4 g/d; North America:the amount of sodium intake should be decreased as age increases). The amount of alcohol intake was generally 30 mL/d for men and 20 mL/d for women. All included guidelines recommended to increase the intake of fruits, vegetables, and potassium. ConclusionCurrently, more than half of diet intervention recommendations for hypertension in different countries and regions are still needs to be improved and modified. Diet recommendations differ in regions, gender, and age.
Acute diarrhea has a high incidence in children. Pediatric tuina has been widely used in children with acute diarrhea in China. However, there is no guideline on the treatment of tuina for children with acute diarrhea. This guideline was developed following evidence-based principles and the World Health Organization handbook for guideline development. The linked systematic review was conducted following the Cochrane handbook. The quality of evidence and the strength of recommendations were evaluated using the GRADE approach. The reporting followed the RIGHT statement. Seven clinical questions (2 foreground questions and 5 background questions) were identified by literature review and expert consensus. Based on the linked systematic review and through comprehensive consideration of the balance of benefit and harm, quality of evidence, patient preferences, and other resources, we formulated the recommendations using Delphi expert consensus. We suggested combination of a weak recommendation for tuina with Western medicine usual care to treat children with acute diarrhea. This guideline can be used by clinicians and nurses in the department of traditional Chinese medicine pediatrics, and department of pediatric tuina, and can also be used as a reference for relevant clinicians of Western medicine and is also applicable to all institutions that practice tuina treatment.