Canadian Thoracic Society: Presenting a new process for clinical practice guideline production

A key mandate of the Canadian Thoracic Society (CTS) is to promote evidence-based respiratory care through clinical practice guidelines (CPGs). To improve the quality and validity of the production, dissemination and implementation of its CPGs, the CTS has revised its guideline process and has created the Canadian Respiratory Guidelines Committee to oversee this process. The present document outlines the basic methodological tools and principles of the new CTS guideline production process. Important features include standard methods for choosing and formulating optimal questions and for finding, appraising, and summarizing the evidence; use of the Grading of Recommendations Assessment, Development and Evaluation system for rating the quality of evidence and strength of recommendations; use of the Appraisal of Guidelines for Research and Evaluation instrument for quality control during and after guideline development and for appraisal of other guidelines; use of the ADAPTE process for adaptation of existing guidelines to the local context; and use of the GuideLine Implementability Appraisal tool to augment implementability of guidelines. The CTS has also committed to develop guidelines in new areas, an annual guideline review cycle, and a new formal process for dissemination and implementation. Ultimately, it is anticipated that these changes will have a significant impact on the quality of care and clinical outcomes of individuals suffering from respiratory diseases across Canada.     

Turkish Thoracic Society asthma management and prevention guideline: key points

Asthma still has high morbidity and cost despite all advances in pathogenesis, diagnosis and treatment. Although asthma can be controlled with proper diagnosis and treatment, the low rates of control in our country and in the world can not be attributed to the variable course of the disease and patients' psycho-social behaviours for chronic disease. In this context, Turkish Thoracic Society (TTS) has decided to update Asthma Diagnosis and Management Guide latest published in 2000. National data were collected, compiled and prepared by authors, and final form given by the TTS Asthma and Allergy Study Group, after presenting to consultant individuals and institutions. In June 2009, the National Asthma Management and Prevention Guideline were published in Turkish. In this paper, we aimed to present the national guide in English with its basics and individual differences.     

2010年英国胸科协会内科胸腔镜指南解读

2010年英国胸科协会在《Thorax））杂志上颁布了“Localanaestheticthoracoscopy：BritishThoracicSocietyPleuralDiseaseGuideline2010”。指南就内科胸腔镜的临床需求、内科胸腔镜作为疾病诊断和治疗工具的证据、内科胸腔镜的适应证及内科胸腔镜的操作等进行了全面阐述。本文重点解读指南的临床实践部分，读者如果需要全面了解指南，请阅读原文。     

恶性胸膜间皮瘤的研究和管理——英国胸科协会指南解读

恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)是一种罕见的累及胸膜的侵袭性肿瘤,迄今尚无关于MPM的大型随机对照研究。英国胸科协会组织了来自呼吸内科、胸外科、肿瘤内科、放射治疗科、影像科、病理学和初级保健科的相关专家,汇总了相关英文文献,于2018年在《胸腔》杂志上发表了恶性胸膜间皮瘤的研究和管理指南[1]。     

英国胸科协会非囊性纤维化支气管扩张指南简介

2010年,英国胸科协会公布了非囊性纤维化支气管扩张指南[1],作为第一个针对支气管扩张的全球性专业指南,首次对支气管扩张的诊疗提出了规范化的指导意见.该指南编写委员会共检索了1803篇有关非囊性纤维化支气管扩张的英文文献,最终汇集了549篇文献,力图提供具有循证医学证据的指导建议(证据分级见表1).由于缺乏大规模临床研究,该指南大部分建议仍源于病例报道及专家意见,部分建议借鉴了囊性纤维化患者的研究,现将该指南的有关成人内容简要介绍如下.     

2010年英国胸科协会胸腔疾病指南:成人胸腔感染的诊治简介

在英国和美国,胸腔感染是常见疾病,其发病率高达80 000人次/年,在英国脓胸患者病死率高达20%,其中约20%患者需要接受手术治疗.迅速评估病情并采取有效治疗是降低发病率和病死率的重要措施.本指南系统性地总结了文献资料并汇总了专家的意见,胸腔感染的诊断和处理流程见图1.如读者需要详细了解指南全部内容,请参阅原文[1].     

2010年英国胸科协会胸膜疾病指南解析：恶性胸腔积液的处理

2010年英国胸科协会在杂志上颁布了“Management of a malignant pleural effusion:British Thoracic Society Pleural Disease Guideline 2010[1]”。指南就恶性胸腔积液的病因、临床表现以及处理等方面进行了全面阐述。本文重点解读指南的临床实践部分，读者如需全面了解指南，请阅读全文。     

2010年英国胸科学会成人单侧胸腔积液诊断指南解读

目前已知胸腔积液病因有50余种,其中包括局限于胸膜或原发于肺部的疾病、系统性疾病、脏器功能异常和药物诱发的胸腔积液等.胸腔积液的发病机制为胸腔内液体生成增多和(或)胸腔内液体吸收减少,其病理生理改变随基础病因不同而有所不同,由于单侧胸腔积液病因多种多样,故系统性诊断非常必要,应该在尽可能减少不必要的侵袭性操作的基础上尽快明确诊断.     

2010年英国胸科学会成人单侧胸腔积液诊断指南解读

目前已知胸腔积液病因有50余种,其中包括局限于胸膜或原发于肺部的疾病、系统性疾病、脏器功能异常和药物诱发的胸腔积液等.胸腔积液的发病机制为胸腔内液体生成增多和(或)胸腔内液体吸收减少,其病理生理改变随基础病因不同而有所不同,由于单侧胸腔积液病因多种多样,故系统性诊断非常必要,应该在尽可能减少不必要的侵袭性操作的基础上尽快明确诊断.     

201O年欧洲肝硬化腹水临床实践指南介绍

欧洲肝病研究会(European Association for the Study of the Liver,EASL)肝硬化腹水临床实践指南[1]依据GRADE系统(Grading of Recommendations Assessment Development and Evaluation)将证据按强度分为三个级别:A(高)、B(中)、C(低);推荐分为两个级别:1(强)、2(弱),见表1.     

2016年欧洲心脏病协会心力衰竭指南解读

<正>在过去30年中,心力衰竭的治疗发生了翻天覆地的变化,显著降低了射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFr EF)患者住院率并提高了生存率,尽管预后仍不尽人意,但近30年的临床研究已证实心力衰竭是可预防和可治疗的疾病。结合近年来临床研究进展,2016年欧洲心力衰竭指南~([1])较2012年版增加了不少新内     

美国胸科医师学会最新肺结节诊疗指南解读

近年来低剂量螺旋CT在我国健康体检中逐渐普及,肺部结节病灶检出率明显增高,而这些结节病灶良恶性判断及处理方法经常成为困扰临床医师及影像科医师的难题。2013年美国胸科医师学会(American College of Chest Physicians,ACCP)发布了第3版单发或多发肺结节(pulmonary nodule)     

Thoracic ultrasound prior to medical thoracoscopy improves pleural access and predicts fibrous septation

Background and objective: Medical thoracoscopy (MT) is indicated for the investigation of unexplained pleural exudates. Not all MT units create artificial pneumothoraces because of time. Difficult pleural space access and thick fibrous adhesions may prevent MT and pleurodesis, respectively. The potential role of thoracic ultrasound (TUS) pre‐MT has not been fully evaluated. We hypothesized TUS would reduce failure to access the pleural space and enable detection of thick fibrous adhesions. Methods: Thirty patients underwent single port MT consecutively for investigation of pleural exudates without pre‐MT TUS over a 6‐month period. Over the following 6 months, 30 consecutive patients underwent TUS immediately prior to MT. Pleural access rate and thick fibrous adhesionn detection at both MT and TUS were recorded. Results: In the non‐TUS cohort, pleural space access failure occurred in 16.7% (leading to five extra procedures), versus no failures in the TUS cohort (P = 0.0522). There were no differences in prevalence of MT fibrous adhesions between cohorts. TUS identified all cases of fibrous septation versus only 12.5% identified by CT in the non‐TUS cohort (P = 0.001). All identified cases of thick fibrous septation on TUS did not receive pleurodesis at MT. TUS detected useful ancillary features in 43% of cases. Conclusions: A strong trend to reduction in single port MT pleural access failure was noted with pre‐MT TUS thus reducing extra procedures and the need for artificial pneumothoraces. Pre‐MT TUS also reliably detects thick fibrous adhesions at MT. TUS may also detect useful ancillary features. This study provides a rationale for ultrasound‐guided single port MT if a pneumothorax is not created.