进展性肺纤维化表现的结缔组织病相关间质性肺疾病患者临床管理(四川省)专家共识

结缔组织病相关间质性肺疾病(connective tissue diseases associated with interstitial lung disease,CTD ILD)很容易出现进展性肺纤维化（progressive pulmonary fibrosis, PPF）表现而预后不良。然而,如何管理PPF表现的CTD ILD患者的临床认识仍然非常有限;如何规范化治疗这部分患者也是经常面临的临床问题。为此,四川省医疗卫生与健康促进会呼吸与危重症医学专业委员会间质性肺疾病学组邀请了省内ILD相关领域专家组成了共识编写组,根据临床收集问题,组织专家讨论,最终确定纳入了5个方面的内容。相关内容主要包括CTD ILD出现PPF的高危因素、临床表现与诊断、病情评估、随访管理和治疗等方面。基于国内外指南、临床研究数据等循证证据,经过多次讨论和投票表决,形成9条推荐意见,共同制定了《PPF表现的CTD ILD患者临床管理（四川省内）专家共识》,旨在提升出现PPF表现的CTD ILD 的临床认识,为临床决策及管理提供依据,提高临床救治水平。     

1999年幽门螺杆菌若干问题的共识意见发表3年后的调查报告

背景：我国为幽门螺杆菌(H．pylori)感染高发地区。1999年制定的H.pylori若干问题的共识意见有助于临床医师正确诊治H.pylori感染患者。目的：了解共识意见发表3年后我国临床医师如何处理H.pylori感染。方法：设计由16个问题组成的问卷调查表，在中华医学会消化病学分会网站和医学空间网站上公布。结果：共收到合格答卷511份，57．1％的医师经常检查H.pylori感染。常用的检测方法是：快速尿素酶试验(RUT)60％，尿素呼气试验(UBT)40％，组织病理学检查36％。治疗H.pylori感染时，74．5％的医师选择三联疗法，19．0％选择四联疗法，5．7％选择二联疗法。50％的医师选用质子泵抑制剂(PPI) 两种抗生素，41％选用铋剂 两种抗生素，34％选用H2受体阻滞剂(H2RA)／PPI 铋剂 两种抗生素，14％选用雷尼替丁构橡酸铋(RBC) 两种抗生素；45％的医师选用呋喃唑酮。93％的医师认为H．pylori耐药是一严重问题。95％的医师选用四联疗法作为补救治疗，或更换更敏感的药物，或增加抗生素的剂量和疗程。83％的医师根除治疗后复查H.pylori感染情况。52％的医师获取诊治H.pylori感染相关信息的来源为1999年H.pylori处理共识意见。结论：共识意见对临床医师正确处理H.pylori感染起重要作用。     

Iberian consensus on cow's milk allergy: The CIBAL Study

Background

The present study explores the professional opinion of a wide range of experts from the Iberian Peninsula (Spain and Portugal) and their degree of consensus about CMPA's prevention, diagnosis, treatment and progression.

新共识指导下的幽门螺杆菌个体化治疗

目的:分析新共识指导下的幽门螺杆菌个体化治疗。方法:收集近来国内外相关报道也进行分析。结果和结论:根除率逐年下降是当前幽门螺杆菌感染根除治疗面临的棘手问题,第四次全国幽门螺杆菌诊断和治疗的共识已经颁布。在新的共识指导下,强调幽门螺杆菌的个体化治疗是提高幽门螺杆菌根除率的关键。     

Urban legends series: Sjögren’s syndrome

Oral Diseases (2012) 19 , 46–58 Sjögren’s syndrome (SjS) is one of the most common autoimmune rheumatic diseases, clinically characterized by xerostomia and keratoconjunctivitis sicca. We investigated the following controversial topics: (i) Do we have reliable ways of assessing saliva production? (ii) How important are the quantity and quality of saliva? (iii) Are only anti‐SSA/Ro and anti‐SSB/La relevant for the diagnosis of SjS? (iv) Are the American‐European Consensus criteria (AECC) the best way to diagnose SjS? Results from literature searches suggested the following: (i) Despite the fact that numerous tests are available to assess salivation rates, direct comparisons among them are scarce with little evidence to suggest one best test. (ii) Recent developments highlight the importance of investigating the composition of saliva. However, more research is needed to standardize the methods of analysis and collection and refine the quality of the accumulating data. (iii) In addition to anti‐Ro/La autoantibodies, anti α‐fodrin IgA and anti‐MR3 autoantibodies seem to be promising diagnostic markers of SjS, but more studies are warranted to test their sensitivity and specificity. (iv) AECC are classification, not diagnostic criteria. Moreover, recent innovations have not been incorporated into these criteria. Consequently, treatment directed to patients diagnosed using the AECC might exclude a significant proportion of patients with SjS.     

抗菌药物在呼吸系统合理应用的最新共识

目的介绍抗菌药物在呼吸系统合理应用的最新共识。方法总结近年来国内外有关呼吸系统感染的诊疗指南、指引、规范和多中心研究成果,尤其是我国呼吸领域的专家共识。结果引入了指导抗菌药物在呼吸系统合理应用的最新循证学成果,纠正了许多错误观点及习惯。结论汇总的共识简明、科学、实用,对临床诊治具有一定的指导意义。     

肝细胞癌癌前病变的诊断和治疗多学科专家共识(2020版)

肝癌目前占我国癌症死因的第二位。我国肝癌的发病特点大多遵循乙型肝炎-肝硬化-肝癌的"三步曲"模式。癌前病变的筛查在胃癌、大肠癌和宫颈癌等恶性肿瘤的诊治中已取得了显著的成果。肝硬化状态下的不典型增生结节具有较强的恶变潜能,尤其是高级别不典型增生结节癌变率极高。基于国内外在这一领域的研究成果和专家临床经验,《肝细胞癌癌前病变的诊断和治疗多学科专家共识(2020版草案)》经多学科协作对肝脏高级别不典型增生结节作为肝癌的癌前病变,从概念、筛查、诊断、治疗和随访等各方面进行了归纳和界定,旨在提出和建立肝癌癌前病变的概念和诊疗原则,为降低我国肝癌的发病率和提高肝癌的总体治疗效果作出贡献。     

老年患者出院准备服务专家共识（2019版）

目的 形成老年患者出院准备服务临床实践专家共识,规范老年患者出院准备服务的相关内容。方法 运用循证方法,按照证据级别高低,检索、评价和汇总该领域的证据,提取与老年患者出院准备服务相关的推荐建议和研究结论,形成共识初稿,通过2轮专家函询和2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。结果 2轮函询专家积极系数均为100%,专家权威程度均为0.83,各指标重要性赋值均数均>3.5,且变异系数均<0.25,专家肯德尔和谐系数分别为0.234和0.253（均P<0.001）。最终对老年患者出院准备服务的概念、主要原则、意义、内容及实施过程5个部分的推荐意见达成一致。 结论 该共识为老年患者出院准备服务在中国的实施提供了指导依据,促进出院准备服务在中国的实施和发展。     

呼吸道传染病产生气溶胶高风险护理操作防护专家共识

目的 制订呼吸道传染病产生气溶胶高风险护理操作防护专家共识（以下简称《共识》）。方法 查阅国内外相关文献,结合临床护理专家工作经验,通过2轮德尔菲专家咨询和专家会议,对《共识》内容进行调整。结果 《共识》包含防护基本要求和护理操作防护要点2个方面。防护基本要求从环境控制、个人防护、行政管控3个维度展开;涉及氧气吸入疗法、机械通气的护理、吸痰、雾化吸入、咽拭子采集、心肺复苏等6个产生气溶胶高风险护理操作防护要点。结论 《共识》具有一定的科学性,可为呼吸道传染病产生气溶胶高风险护理操作的防护提供临床指导。     

Clinical validation of expert consensus statements for respiratory physiotherapy management of invasively ventilated adults with community-acquired pneumonia: A qualitative study

ObjectivesTo conduct multidisciplinary peer-review of expert consensus statements for respiratory physiotherapy for invasively ventilated adults with community-acquired pneumonia, to determine clinical acceptability for development into a clinical practice guideline.Research methodologyA qualitative study was undertaken using focus groups (n = 3) conducted with clinician representatives from five Australian states. Participants were senior intensive care physiotherapists, nurses and consultants. Thematic analysis was used, with a deductive approach to confirm clinical validity, and inductive analysis to identify new themes relevant to the application of the 38 statements into practice.SettingAdult intensive care.FindingsSenior intensive care clinicians from physiotherapy (n = 16), medicine (n = 6) and nursing (n = 4) participated. All concurred that the consensus statements added valuable guidance to practice; twenty-nine (76%) were deemed relevant and applicable for the intensive care setting without amendment, with modifications suggested for remaining nine statements to enhance utility. Overarching themes of patient safety, teamwork and communication and culture were identified as factors influencing clinical application. Cultural differences in practice, particularly related to patient positioning, was evident between jurisdictions. Participants raised practicality and safety concerns for two statements related to the use of head-down patient positioning.ConclusionMultidisciplinary peer-review established clinical validity of expert consensus statements for implementation with invasively ventilated adults with community-acquired pneumonia.