《中国超药品说明书用药管理指南(2021)》推荐意见及要点解读

超药品说明书用药在某些情况下是诊疗的合理需求,但其面临潜在的用药安全和法律风险。对于如何指导中国的超药品说明书用药管理,至今尚无相关指南,故北京协和医院牵头,与兰州大学循证医学中心共同组织临床、药学、循证医学、法律和医院管理等多学科领域专家,根据《中华人民共和国医师法》关于超药品说明书用药的规定以及《世界卫生组织指南制定手册》相关指南制订方法,制定了《中国超药品说明书用药管理指南(2021)》。这是我国第一部关于超药品说明书用药的管理指南,共确定9个问题,并形成了23条推荐意见。指南的英文版本Management guideline for the off-label use of medicine in China(2021) 已于2022年9月发表,本文对该指南要点进行全面解读,以期提高临床对该问题的认识,为建立标准化的超药品说明书用药管理程序提供参考和帮助。     

2021年英国皮肤科医师协会《玫瑰痤疮管理指南》解读

2021年5月,英国皮肤科医师协会发布了《玫瑰痤疮管理指南》,对玫瑰痤疮的病因、疾病发展史、诊断及鉴别诊断、治疗及其预后随访等方面提出了全面的临床指导意见。本文对该指南进行解读,并与中国2021年版玫瑰痤疮管理指南进行对比,以期为我国玫瑰痤疮的诊治提供参考。     

依据最新指南盘点左心室射血分数正常心力衰竭的研究现状

近年来国内外相继公布了2010年射血分数正常心力衰竭诊治的中国专家共识、2012年欧洲心脏病学会（ESC）急性／慢性心力衰竭诊断治疗指南和2013年美国心脏病学会基金会／美国心脏病协会（ACCF／AHA）心力衰竭管理指南，而2013版中国成人心力衰竭诊断治疗指南也将在2014年正式公布。各个指南虽然在语言表述或侧重点上有所不同，但都是对相关的循证医学证据进行分析整合，然后作出了不同推荐水平和证据级别的推荐，     

2013-2014年度高血压临床指南的现状分析及循证临床指南评价

目的调查分析2013-2014年国内外公布的新版高血压临床指南,采用 AGREEⅡ工具评价高血压防治指南质量,为我国高血压临床指南的制定提供参考。方法计算机检索 CNKI、Wanfang Data、PubMed、Medline 及相关机构认可和授权的网站,收集2013-2014年国内外公开发表的高血压临床指南,及2009至2014年国内外公开发表的高血压防治临床指南相关资料,按照纳入和排除标准筛选文献。描述性分析纳入指南名称、发表年份、机构、开发方法、参考文献数目等内容。采用 AGREEⅡ工具评价2013-2014年国内外新版高血压临床指南的质量。结果共纳入高血压防治临床指南10部。评价结果表明,2013-2014年国内外高血压临床指南在表达的清晰性上得分最高,平均得分83．6％;其次为范围和目的,平均得分79．2％;参与人员项平均得分65．8％;适用性平均得分63．6％;编辑的独立性平均得分63．3％;严谨程度平均得分最低,为60．1％。指南总体评估显示,欧洲2013版、加拿大2013版、中国2013版、2014 JNC8版、2014 ASH／ISH 版、日本2014版、2013 AHA ／ACC ／CDC 版为积极推荐使用的指南,法国2013版、印度2013版、2013中国 RH 指南为推荐使用的指南（尚需补充和改进）,没有不推荐或不确定的指南。结论2013-2014年国内外高血压防治指南总体质量较高,发展中国家制定的指南质量明显提高,但与目前公认的循证医学要求仍存在差距,指南制定方法尚需规范。而建立科学、规范、适合国情的临床指南制定和评价体系,同期公布多版本的成套临床指南,有利于临床指南的推广实施。     

中国艾滋病诊疗指南(2021年版)

2005年中华医学会感染病学分会艾滋病丙型肝炎学组制订了第一版《艾滋病诊疗指南》,并于2011年、2015年和2018年分别进行了更新.2021年版指南是在第四版指南的基础上进行修订,并根据我国临床实践和最新研究结果进行了内容更新.本版指南更新了机会性感染、抗反转录病毒治疗、暴露后预防、暴露前预防、人类免疫缺陷病毒感染...     

急性心力衰竭诊治要点及临床治疗

急性心力衰竭作为临床危重症之一,死亡率极高、预后极差。但是近些年来,关于急性心力衰竭诊治的新进展报道较少。随着2014年我国及2016年欧洲心力衰竭指南陆续颁布,对急性心力衰竭诊断思路以及治疗方案提出了部分新意见。本文结合最新指南以及新近文献,对急性心力衰竭诊治要点及临床治疗进展进行综述。     

慢性心力衰竭健康管理综合评价指标的证据总结

目的:总结慢性心力衰竭健康管理综合评价指标的最佳证据.方法:检索NGC、SIGN、PubMed、Web of Science、CINAHL、Cochrane图书馆、中国知网、万方、中国生物医学等数据库,自建库到2021年1月发表的关于慢性心力衰竭健康管理的文献,选取符合标准的临床指南、专家共识、系统评价及原始研究,并评...     

2016年欧洲心脏病学会急性心力衰竭指南解读

2016年5月20日,欧洲心脏病学会（European Society of Cardiology,ESC）发布新版的《急、慢性心力衰竭诊断和治疗指南》［1］（以下简称“新指南”）。该指南详细阐述了急、慢性心力衰竭诊断及治疗领域的最新视点,其中有一部分专门讲述急性心力衰竭（acute heart failure,AHF）的诊治,这是近5年来 ESC 关于 AHF 发布的第三版指南［2-3］。新指南较 ESC 以往版本以及2014年我国心力衰竭诊治指南［4］的急性心力衰竭部分和英国国家卫生与临床优化研究所（National Institute for Health and Clinical Excellence,NICE）公布的急性心力衰竭指南［5］比较,均有了新的推荐和要求。众所周知,AHF 起病急骤且常危及生命,需要紧急处理。因此,急诊及院前急救医护人员熟识 AHF诊治的理论知识及技术对于提高 AHF 的救治质量、降低病死率、节省医疗花费均具有重要意义。为推广及普及 AHF 诊疗的国际新进展,结合目前我国AHF 诊治现状,特对新指南中急性心力衰竭诊疗部分做简要解读。     

2021年版《中国血糖监测临床应用指南》护理实践解读

中华医学会糖尿病学分会组织专家根据新的循证医学证据编写发布了《中国血糖监测临床应用指南（2021年版）》，该指南罗列出各种血糖监测的方法及特点，临床应用的意义。本文围绕指南中护理实践部分进行解读，以期为临床护士的血糖监测操作提供指导，规范血糖监测、并为护理人员使用血糖监测方法提供参考。进一步提高糖尿病管理水平，为诊疗提供依据。     

2021版《儿童肿瘤及造血干细胞移植病人口腔黏膜炎的预防指南》解读

对2021版《儿童肿瘤及造血干细胞移植病人口腔黏膜炎的预防指南》进行解读,介绍口腔黏膜炎的定义、分级以及预防措施,以期为医务人员理解指南并在临床实践中更好地应用提供便利。     

免疫检查点抑制剂相关心肌炎临床诊疗实施建议

免疫检查点抑制剂（immune-checkpoint inhibitors，ICIs）现已应用于多种恶性肿瘤的治疗，为肿瘤患者带来获益的同时，其严重ICIs相关心肌炎日益为临床带来新挑战。本临床诊疗实施建议聚焦ICIs相关心肌炎的危险因素、诊断与鉴别诊断、临床分型及治疗、监测转归和治疗重启等关键临床问题，参考国内外相关共识或指南和新近发表的循证证据，结合实际临床经验，为ICIs相关心肌炎的诊疗提供具有实践性的指导意见和建议。     

Heart failure: metabolic derangements and therapeutic rationale

In the USA, over two-thirds of patients with heart failure (HF) are cared for by primary care practitioners exclusively. Significant progress has been made through basic science and clinical research focusing on the prevention of HF via control of known risk factors. There has also been a great deal of progress in both pharmacologic and nonpharmacologic management of the disease. These therapeutic interventions, however, continue to be underutilized, with seemingly inadequate translation of new evidence and updated guidelines (American College of Cardiology/American Heart Association, European Society of Cardiology, Canadian Cardiovascular Society, and Heart Failure Society of America updates in 2005-2006) into clinical practice. In this review, we discuss the pathophysiology of HF in addition to the metabolic derangements and therapeutic rationale surrounding current treatment options, with a particular focus on the interventions that have been shown and recommended in updated guidelines to prevent the disease or halt its progression.     

Heart failure: metabolic derangements and therapeutic rationale

In the USA, over two-thirds of patients with heart failure (HF) are cared for by primary care practitioners exclusively. Significant progress has been made through basic science and clinical research focusing on the prevention of HF via control of known risk factors. There has also been a great deal of progress in both pharmacologic and nonpharmacologic management of the disease. These therapeutic interventions, however, continue to be underutilized, with seemingly inadequate translation of new evidence and updated guidelines (American College of Cardiology/American Heart Association, European Society of Cardiology, Canadian Cardiovascular Society, and Heart Failure Society of America updates in 2005–2006) into clinical practice. In this review, we discuss the pathophysiology of HF in addition to the metabolic derangements and therapeutic rationale surrounding current treatment options, with a particular focus on the interventions that have been shown and recommended in updated guidelines to prevent the disease or halt its progression.     

《2021年美国胃肠病学会结直肠癌筛查指南》解读

2021年3月,Am J Gastroenterol在线发表了美国胃肠病学会《2021年美国胃肠病学会结直肠癌筛查指南》,筛查的目标是切除腺瘤和无蒂锯齿状息肉,并检测早期结直肠癌。2021年指南在2009年指南的基础上提出尚未解决的问题,并进行了全面的文献检索和讨论,为结直肠癌的筛查提供了更全面、具体的建议。在此,本文就ACG 2021年指南从筛查年龄、筛查方式、结直肠癌的化学预防等方面进行解读,从而优化结直肠癌筛查,有效、持续地降低结直肠癌发病率和病死率。     

如何根据临床指南进行个体化治疗——从脓毒症与感染性休克治疗国际指南说起

脓毒症一直是全球死亡的主要原因.基于循证医学证据的脓毒症治疗指南推动了全球对脓毒症的认知,持续强化了医务人员对脓毒症发生发展的理解,不断规范临床治疗,为临床医疗行为标准的建立提供了依据,是"个体化"治疗实施的前提.当面对患者个体时,指南推荐意见不能完全代替临床医生的决策能力,所有诊疗决策需根据患者自身的病理生理特点进行...     

Diagnosis and Treatment of Viral Myocarditis

Myocarditis, an inflammatory disease of heart muscle, is an important cause of dilated cardiomyopathy worldwide. Viral infection is also an important cause of myocarditis, and the spectrum of viruses known to cause myocarditis has changed in the past 2 decades. Several new diagnostic methods, such as cardiac magnetic resonance imaging, are useful for diagnosing myocarditis. Endomyocardial biopsy may be used for patients with acute dilated cardiomyopathy associated with hemodynamic compromise, those with life-threatening arrhythmia, and those whose condition does not respond to conventional supportive therapy. Important prognostic variables include the degree of left and right ventricular dysfunction, heart block, and specific histopathological forms of myocarditis. We review diagnostic and therapeutic strategies for the treatment of viral myocarditis. English-language publications in PubMed and references from relevant articles published between January 1, 1985, and August 5, 2008, were analyzed. Main keywords searched were myocarditis, dilated cardiomyopathy, endomyocardial biopsy, cardiac magnetic resonance imaging, and immunotherapy.ACCF/AHA/ESC = American College of Cardiology Foundation/American Heart Association/European Society of Cardiology; CK-MB = creatine kinase—MB isoenzyme; DCM = dilated cardiomyopathy; ECMO = extracorporeal membrane oxygenation; EF = ejection fraction; LV = left ventricular; LVEF = left ventricular ejection fraction; MRI = magnetic resonance imaging; PCR = polymerase chain reactionMyocarditis is an important and often unrecognized cause of dilated cardiomyopathy (DCM). It is defined as inflammation of the heart muscle that may be identified by clinical or histopathologic criteria. Recent developments in the diagnosis and treatment of patients with suspected myocarditis include improved histologic criteria and use of cardiac magnetic resonance imaging (MRI). The aim of this review is to provide a contemporary evidence-based approach to evaluation and treatment of patients with suspected myocarditis. Main keywords searched are as follows: myocarditis, dilated cardiomyopathy, endomyocardial biopsy, cardiac magnetic resonance imaging, and immunotherapy. Articles were screened on the premise of importance, quality, and relevance.     

Update on the clinical management of atrial fibrillation: guidelines and beyond

In clinical practice, atrial fibrillation (AF) is the most commonly encountered arrhythmia. With the aging of the US population, the number of patients with AF that physicians encounter will increase. Atrial fibrillation management involves a combination of rate- and rhythm-control strategies with thromboprophylaxis, a complicated endeavor given side effect profiles of treatments, patient comorbidities, and anticoagulation treatment requirements. Early treatment discontinuation and poor compliance with anticoagulation treatment are frequent and result in increased mortality, a 5-fold increased risk of ischemic stroke, decreased health-related quality of life, and decreased exercise capacity. In 2006, the American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) provided guidelines for the management of patients with AF. Recently, the ACC Foundation, AHA, and Heart Rhythm Society released updates to these guidelines (January and February 2011). This article aims to assist physicians in improving the management of patients with AF by focusing on the main components of therapy as reflected in the guidelines, and by providing an update on new US Food and Drug Administration-approved treatments.     

Robotic technology and physical medicine and rehabilitation

In this opinion piece, I will revisit the basis for our belief that robotic manipulation is a valid approach to promote speedier and better recovery following a stroke and discuss some of the clinical evidence that led to the September 2010 guidelines for stroke care of the American Heart Association as well as the December 2010 guidelines of the Veterans Administration endorsing the use of robotic technology for the upper extremity (UE) but not for the lower extremity (LE) post-stroke rehabilitation effort.     

A Perspective on the New American College of Cardiology/American Heart Association Guidelines for Cardiovascular Risk Assessment

The recently published American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for cardiovascular risk assessment provide equations to estimate the 10-year and lifetime atherosclerotic cardiovascular disease (ASCVD) risk in African Americans and non-Hispanic whites, include stroke as an adverse cardiovascular outcome, and emphasize shared decision making. The guidelines provide a valuable framework that can be adapted on the basis of clinical judgment and individual/institutional expertise. In this review, we provide a perspective on the new guidelines, highlighting what is new, what is controversial, and potential adaptations. We recommend obtaining family history of ASCVD at the time of estimating ASCVD risk and consideration of imaging to assess subclinical disease burden in patients at intermediate risk. In addition to the adjuncts for ASCVD risk estimation recommended in the guidelines, measures that may be useful in refining risk estimates include carotid ultrasonography, aortic pulse wave velocity, and serum lipoprotein(a) levels. Finally, we stress the need for research efforts to improve assessment of ASCVD risk given the suboptimal performance of available risk algorithms and suggest potential future directions in this regard.