Heart failure with preserved ejection fraction (HFpEF) is the main type of heart failure (HF), accounting for more than half of the incidence of HF. However, the etiology, pathogenesis, treatment and prognosis of HFpEF are still not fully understood. Recommendations for HFpEF are in different chapters in the 2022 AHA/ACC/HFSA guideline for the management of heart failure. This paper interpreted the definition, stage, diagnosis, epidemiology, clinical evaluation, stage treatment, acute attack stage, comorbidity management, vulnerable population and research prospect of HFpEF, which aimed to provide the latest thinking in terms of the management of HFpEF for clinicians.
Due to the special structure and material of the flexible gastrointestinal (GI) endoscopes, it is difficult to reprocess endoscopes. Infections caused by endoscope reprocessing failure often occur. Strict implementation of the guidelines/relevant national standards and manufacturer's instructions is essential to prevent the occurrence of endoscopy-related infections and ensure patient safety. In 2020, ASGE (American Society for Gastrointestinal Endoscopy) released the "multisociety guideline on reprocessing flexible GI endoscopes and accessories". This paper aimed to promote the understanding of the reprocessing process of flexible GI endoscopes by the endoscope decontamination staff, and to provide references for clinical practice.
Radiation proctopathy, which can be categorized as acute and chronic, is defined as the radiation damage to the rectum caused by radiation therapy in patients with pelvic malignancies. Chronic radiation proctopathy can cause complications such as rectal bleeding, which severely affects patients’ quality of life. At present, endoscopic therapy has become the primary method for diagnosis and treatment of bleeding from chronic radiation proctopathy. In October 2019, the American Society for Gastrointestinal Endoscopy (ASGE) published "ASGE guideline on the role of endoscopy for bleeding from chronic radiation". The guideline described the effectiveness and safety of different endoscopic therapies such as argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, cryoablation, etc. in the treatment of bleeding from chronic radiation. This paper interprets it to provide references for clinicians in the treatment of bleeding from chronic radiation.
Chinese guideline for diagnosis and treatment of osteoarthritis (2021 edition) was published in the Chinese Journal of Orthopaedics, providing abundant recommendations on osteoarthritis (OA) issues. In this paper, the methodological and reporting qualities of the guideline were explained and assessed by using quality appraisal tools, such as appraisal of guidelines research and evaluation-China (AGREE-China), Institute of Medicine Committee (IOM), and reporting items for practice guidelines in healthcare (RIGHT). It also aimed to provide personalized treatments for specific patients, support readers in understanding the principle of OA treatment, and standardize OA treatment strategies. In addition, this study would contribute to the clinical promotion of the current guidelines and provide the necessary references for clinical practice guidelines in treating OA in the future.
Directed acyclic graphs (DAGs) are essential tools based on prior assumptions, capable of clearly depicting causal relationships between variables, aiding in the identification of confounders and assessment of bias. They have been widely applied in the field of epidemiology. However, the construction of DAGs is prone to the subjectivity of researchers. This paper interprets the DAGs construction and application guidelines from the BMJ and elaborates on the seven steps for building DAGs: clarifying the research question and target population, identifying relevant variables, reaching consensus and pre-registering, determining data collection or datasets based on the consensus graph, selecting analysis methods and variable measurement, conducting sensitivity analysis, and reporting the DAGs. By following these steps, researchers can construct DAGs more scientifically, identify the minimal sufficient adjustment set, and enhance the scientific validity and reliability of their studies. Despite its advantages, DAGs have limitations. For instance, failure to consider all relevant factors may lead to unexplained disturbances in the analysis results or incorrect causal inferences, thus failing to verify other key assumptions in causal reasoning. Therefore, it is recommended to integrate DAGs with data-driven methods to maximize their strengths and compensate for their shortcomings.
China Association of Chinese Medicine officially issued the clinical guidelines for diagnosis and treatment of frozen shoulder in traditional Chinese medicine (T/CACM 1416-2022) on November 14th, 2022. The guideline covers clinical diagnosis, treatment, prevention and care of frozen shoulder. This paper introduces the background of this guideline and interprets its contents of clinical diagnosis, treatment and prevention. It helps the applicable population deepen their understanding and standardization of traditional Chinese medicine in the prevention and treatment of frozen shoulder, and provides references for the development of relevant guidelines in traditional Chinese medicine orthopedics in the future.
Gout is the most common inflammatory arthritis, which is characterized by elevated urate and monosodium urate (MSU) crystal deposition in tissues, leading to arthritis, soft-tissue masses (tophi), nephrolithiasis, and urate nephropathy. It has a major impact on health-related quality of life. The American College of Rheumatology (ACR) published ACR guidelines for the management of gout in June 2020, in which 42 recommendations (including 16 strong recommendations) were generated. The guideline described indications for urate-lowering therapy (ULT), approaches to initiating, ongoing management, gout flares, and lifestyle and other medication strategies in patients with gout and in individuals with asymptomatic hyperuricemia. This paper interprets it to provide references for clinical practice.