牙源性肿瘤诊疗指南

牙源性肿瘤的发生与牙的发育密切相关,其发病、临床表现及治疗等均具有特殊性,是口腔颌面外科特有的一类肿瘤。牙源性肿瘤的发病率高,占口腔颌面部肿瘤的6%,其基本治疗是以手术治疗为主的综合序列治疗。中华口腔医学会口腔颌面外科专业委员会肿瘤学组组织相关专家,结合国内外牙源性肿瘤相关文献及2005年WHO头颈肿瘤新分类,制定了《牙源性肿瘤诊疗指南》,希望对规范牙源性肿瘤的诊断与治疗起到指导作用。本指南将根据基础与临床研究的最新成果及时更新。     

中国女性乳腺癌筛查标准(T/CPMA 014-2020)

前言本文件按照GB/T 1.1-2020《标准化工作导则第1部分:标准化文件的结构和起草规则》的规定起草。本文件由国家癌症中心提出。本文件由中华预防医学会归口。本文件起草单位:国家癌症中心、南京医科大学、天津医科大学肿瘤医院、中国医学科学院肿瘤医院深圳医院、兰州大学、中国医科大学、湖南省肿瘤医院、河北医科大学第四医院、河南省肿瘤医院、四川省肿瘤医院。     

护理领域中临床实践指南依从性的研究进展

临床实践指南是连接证据和实践的重要桥梁，实施指南可提高护理实践的科学性。然而指南的实施过程复杂，医护人员对指南的依从性较低，影响指南的实施效果。指南的制订、传播和实施是一个连续的过程，各环节均可能存在影响指南依从性的因素。该文基于护理领域综述了临床实践指南依从性的发展历程、现状、评价方法以及影响因素，旨在探讨提高指南依从性的策略，为指南的制订、传播及实施提供理论参考。     

Clinical characteristics,etiological profile,treatment and long term outcomes in patients with non ischemic systolic heart failure; Himachal Pradesh heart failure registry (HP–HF registry)

BackgroundThe data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF.Methods1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke.ResultsPatients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up.ConclusionsPatients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment.     

《循证针灸临床实践指南:贝尔面瘫》质量评价及解读＊

目的 评价2011年版和2018年版《循证针灸临床实践指南：贝尔面瘫》质量。方法 由4名评价人员独立运用AGREE II、Shaneyfelt和Grilli三个评价工具对两版《指南》进行质量评估，并解读2018年版《指南》内容。结果 两版指南AGREE II的标化百分比分别为：范围和目的51%、83%，参与人员43%、78%，制定的严谨性14%、86%，表达的明晰性60%、92%，应用性17%、64%，编辑独立性96%、100%；Shaneyfelt量表平均得分为7.5分和20.75分；Grilli量表平均得分为1.5分和2.5分；2018年版《指南》更加严谨科学。结论 2018年版《指南》弥补了2011年版《指南》的部分不足，建议结合临床实践的具体反馈不断更新完善。     

肝硬化门静脉高压消化道静脉曲张内镜下组织胶注射治疗专家共识（2022，长沙）

肝硬化门静脉高压可引起全消化道静脉曲张。内镜下组织胶注射在消化道静脉曲张的治疗中起着重要作用，然而目前国内外尚无规范化治疗的相关共识。2022年，中华医学会消化内镜学分会食管与胃静脉曲张内镜诊断与治疗学组组织全国相关领域权威专家讨论，提出了肝硬化门静脉高压消化道静脉曲张内镜下组织胶注射治疗专家共识，以期规范该技术在消化道静脉曲张中的应用。本共识共分为肝硬化门静脉高压症消化道静脉曲张分型及诊断、组织胶注射治疗消化道静脉曲张的适应证等11个部分，共22条陈述。     

Parental perspectives on Phelan-McDermid syndrome: Results of a worldwide survey

Phelan-McDermid syndrome (PMS) is a rare neurodevelopmental disorder characterised by hypotonia, speech problems, intellectual disability and mental health issues like regression, autism and mood disorders. In the development, implementation and dissemination of a new clinical guideline for a rare genetic disorder like PMS, the parental experienced perspective is essential. As information from literature is scarce and often conflicting the European Phelan-McDermid syndrome guideline consortium created a multi-lingual survey for parents of individuals with PMS to collect their lived experiences with care needs, genotypes, somatic issues, mental health issues and parental stress. In total, we analysed 587 completed surveys from 35 countries worldwide. Based on parental reporting, PMS appeared to be caused by a deletion of chromosome 22q13.3 in 78% (379/486) of individuals and by a variant in the SHANK3 gene in 22% (107/486) of the individuals. Parents reported a wide variety of developmental, neurological, and other clinical issues in individuals with PMS. The most frequently experienced issues were related to speech and communication, learning disabilities/intellectual disability, and behaviour. While most reported issues were present across all age groups and genotypes, the prevalence of epilepsy, lymphoedema, and mental health issues do appear to vary with age. Developmental regression also appeared to begin earlier in this cohort than described in literature. Individuals with PMS due to a 22q13.3 deletion had a higher rate of kidney issues and lymphoedema compared to individuals with SHANK3 variants. Parental stress was high, with specific contributing factors being child and context related in accordance with the PMS phenotype. The survey results led to various validated recommendations in the European PMS guideline including an age specific surveillance scheme, specific genetic counselling, structured healthcare evaluations on sleep and communication and a focus on family well-being.     

ESPEN guideline on chronic intestinal failure in adults – Update 2023

Background & aimsIn 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines.MethodsThe grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly.ResultsThe recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is “strong consensus” for 148 (99.3%) and “consensus” for one (0.7%) recommendation. The grade of consensus for the statements is “strong consensus” for 14 (87.5%) and “consensus” for two (12.5%).ConclusionsIt is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.