中国临床戒烟指南(2007年版,试行本)

前言 2006年1月世界卫生组织(WHO)<烟草控制框架公约>(FCTC)在中国已经正式生效,其中第14条明确提出,每一缔约方应考虑到国家现状和重点,制定和传播以科学证据和最佳时间为基础的适宜、综合和配套的指南,并应采取有效的措施以促进戒烟和对烟草依赖的适当治疗.为了履行FCTC,推动中国的戒烟服务,特制定此指南.     

《中国高血压防治指南》(试行本摘要)

高血压是最常见的心血管病 ,我国 1991年抽样普查 ,高血压标化患病率为 11 2 6 % ,与 1979～ 1980年相比 ,10年间患病率增加 2 5 % ,且目前仍有增加的趋势。据此 ,卫生部和中国高血压联盟组织国内专家 ,对我国的高血压病诊断、治疗标准进行自 195 9年以来的第 5次全面修改。目的是根据我国当前的条件和国际上的共识 ,指导内科及心血管病专业医生防治高血压病。治疗高血压的目的不仅在于降低血压本身 ,还在于全面降低心血管病的发病率和病死率。高血压患者的心血管病危险是多因素的 ,因此 ,高血压的治疗还应包括影响高血压患者其他危险因素的…     

解读《中国血糖监测临床应用指南》(2011年版)

血糖监测是糖尿病综合管理的重要组成部分,贯穿糖尿病治疗与疗效评估的全过程.自我血糖监测(SMBG)是血糖监测的基本形式,在不同的糖尿病阶段,因各自治疗措施和特点不同,需要相应的SMBG方案.糖化血红蛋白(Hb)A1c是反映长期血糖控制水平的金标准,但其检测方法需进行标准化.而动态血糖监测(CGM)可以提供连续、全面、可靠的全天血糖信息.糖化血清白蛋白(GA)反映短期内血糖变化比HbA1c敏感,是评价患者短期糖代谢控制情况的良好指标,二者有其自身的特点和优势,是上述监测方法的有效补充.     

《中国艾滋病诊疗指南(2018版)》解读

《中国艾滋病诊疗指南(2018版)》是根据我国临床实践和基于中国人群的研究数据以及国际最新研究结果在前三版的基础上进行的更新。此版指南强化了艾滋病预防的理念,突出了核酸检测在诊断和治疗中的价值,大幅度更新了艾滋病合并结核病和隐球菌脑膜炎治疗方案,优化了抗病毒治疗推荐方案,更新了抗病毒治疗失败的定义及其处理规范。此外,此版指南首次规范了HIV单阳家庭的生育问题,并首次提出HIV感染的全程管理理念。此版指南是一部既具中国特色又与国际接轨的指南,很多理念如全程管理、个体化治疗、单阳家庭生育、治疗药物浓度监测、HIV暴露前预防和简化治疗等都是首次提出或首次写入中国指南,体现了中国学者对该研究领域的贡献。     

《慢性乙型肝炎防治指南》(2019年版)解读

<正>2005年我国出台首部《慢性乙型肝炎防治指南》,确立了抗病毒治疗的基础地位,随后又分别于2010年、2015年对该指南进行了修订和更新。近5年来,国内外有关慢性乙型病毒性肝炎(简称慢性乙肝)的基础和临床研究取得了很大进展,新的治疗理念得到认可,新的治疗药物得到批准,新的流行病学数据得以公布。     

《猴痘诊疗指南(2022年版)》解读

猴痘是由猴痘病毒引起的人畜共患传染病,主要表现为发热、剧烈头痛、淋巴结肿大、皮疹等。该病主要流行于非洲的西部和中部。2022年5月以来,全球非流行国家暴发了猴痘疫情,且存在社区传播。猴痘大部分临床过程呈自限性,少数出现严重并发症,甚至危及生命。为提高临床早期识别和规范诊疗能力,国家卫生健康委员会制定了《猴痘诊疗指南(2022年版)》。本文结合相关研究进展对指南进行解读,内容覆盖了猴痘的病原学、流行病学、临床表现、实验室检查、诊断和鉴别诊断、治疗及医疗机构内感染预防与控制等,以提高临床医师对猴痘的认识。     

《原发性肝癌诊疗指南(2022年版)》更新要点解读

自《原发性肝癌诊疗规范(2019年版)》发布以来,国内外在肝癌诊治领域涌现出许多新的循证医学高级别证据,尤其是多项符合中国肝癌患者诊疗的研究成果相继发表。为进一步规范我国肝癌诊疗行为,国家卫生健康委员会组织全国肝癌领域的多学科专家,更新并发布了《原发性肝癌诊疗指南(2022年版)》,旨在实现《“健康中国2030”规划纲要》提出的2030年总体癌症5年生存率提高15%的目标。本文将对2022年版指南的主要更新要点进行解读,以期推动新版指南的广泛传播与实施。     

2004年《中国高血压防治指南(实用本)》颁布

2004年《中国高血压防治指南(实用本)》已正式颁布。该指南是根据近年来大量有关高血压流行病学及循证医学研究结果，参照各国高血压防治指南，经国内心血管、内分泌等相关领域专家反复讨论，在1999年《中国高血压防治指南》的基础上修订而成。     

《中国肺动脉高压诊断与治疗指南(2021版)》解读——指南撰写的方法学

近年来肺动脉高压(pulmonary hypertension,PH)领域取得了许多进展,诊断及治疗策略不断更新.来自国内外的专家也发表了 PH系列指南和专家共识.由于PH的诊断涉及多学科,容易造成误诊、漏诊,其治疗不规范也较普遍;为更好指导我国医师的临床实践,中华医学会呼吸病学分会肺栓塞与肺血管病学组、中国医师协会呼...     

Statistical analysis of daily smoking status in smoking cessation clinical trials

Aims Smoking cessation trials generally record information on daily smoking behavior, but base analyses on measures of smoking status at the end of treatment (EOT). We present an alternative approach that analyzes the entire sequence of daily smoking status observations. Methods We analyzed daily abstinence data from a smoking cessation trial, using two longitudinal logistic regression methods: a mixed‐effects (ME) model and a generalized estimating equations (GEE) model. We compared results to a standard analysis that takes abstinence status at EOT as outcome. We evaluated time‐varying covariates (smoking history and time‐varying drug effect) in the longitudinal analysis and compared ME and GEE approaches. Results We observed some differences in the estimated treatment effect odds ratios across models, with narrower confidence intervals under the longitudinal models. GEE yields similar results to ME when only baseline factors appear in the model, but gives biased results when one includes time‐varying covariates. The longitudinal models indicate that the quit probability declines and the drug effect varies over time. Both the previous day's smoking status and recent smoking history predict quit probability, independently of the drug effect. Conclusion When analysing outcomes of studies from smoking cessation interventions, longitudinal models with multiple outcome data points, rather than just end of treatment, can makes efficient use of the data and incorporate time‐varying covariates. The generalized estimating equations approach should be avoided when using time‐varying predictors.     

Common predictors of smoking cessation in clinical practice

Although smoking cessation is clearly beneficial, many smokers respond poorly to smoking cessation efforts with rather disappointing overall success rate of long-term abstinence. The perceived lack of effectiveness of smoking cessation may well influence how physicians set their priorities with regard to an effective use of their consultation time. Negative beliefs and attitudes can be resolved by advancing the general understanding of the natural history of quitting, by making sensible use of smoking cessation services, and by being aware of the correct use of drugs for nicotine dependence when prescribed. In particular, a better understanding of predictors of success in smoking cessation can help physicians in identifying smokers who stand a fair chance of quitting. The purpose of the present article is to review those predictors of smoking cessation that can be of help in routine clinical consultation.     

Strategies for smoking cessation

Cigarette smoking is the leading preventable cause of death in the United States, accounting for more than 400,000 deaths annually. Recent advances in the treatment of smoking cessation and prevention of relapse offer promise to many smokers, especially vulnerable smokers such as those with coronary heart disease and other cardiovascular disease. Varenicline, a newly approved medication for smoking cessation, is a welcome addition to the clinician’s treatment arsenal. Other options for treatment include new uses of traditional nicotine replacement therapy (NRT), such as the simultaneous use of two forms of NRT or starting NRT prior to the quit-smoking date. A combination of pharmacologic and nonpharmacologic strategies is appropriate for most smokers and effectively doubles quit rates compared with rates in smokers who try to quit without the help of a clinician. Drawing appropriately from existing therapeutic options, the clinician should aim to treat smokers at all levels of interest in quitting.     

Effective treatment for smoking cessation

An effective method of cigarette smoking cessation using acupuncture is described. From May 1976 to December 1982, 514 patients were treated. Of 339 evaluable patients, 297 stopped smoking, for a success rate of 88 percent. In a two-year follow-up, the rate of relapse was 31 percent. The possible mechanisms by which this technique works are discussed.     

Non-nicotine pharmacotherapies for smoking cessation

International chronic obstructive pulmonary disease guidelines recommend that smokers be strongly advised to quit, and should be offered help in doing so. The most effective smoking-cessation interventions combine behavioural support with pharmacotherapies. For smokers who do not wish to use nicotine replacement treatments, bupropion is a safe and effective non-nicotine alternative first-line treatment. Nortriptyline and clonidine have demonstrated efficacy in aiding smoking cessation, but are regarded as second-line therapies. A number of other non-nicotine treatments show promise, but more data are required before these can be recommended in assisting smokers to stop.     

Community resources for smoking cessation

Cigarette smoking continues to be the single largest preventable cause of premature death in the United States. Unfortunately, smoking cessation rates in the United States have stalled despite the availability of effective smoking cessation treatments. Although community-based smoking cessation services delivered in person, via the phone, and via the Internet have been shown to be effective channels of intervention, few smokers actually use the services for smoking cessation treatment. Recent studies suggest that pursuing innovative strategies may lead to increased reach and a potential increase in cessation rates. As such, researchers and clinicians can take advantage of these strategies and programs to help promote smoking cessation resources that can be used to effectively treat nicotine dependence and ultimately reduce cardiovascular disease and cancer.     

Methods for smoking cessation.

Smoking cessation treatment consists of three phases: preparation, intervention, and maintenance (support and coping strategies). Although most people who quit smoking do so without going through a formal program, many people act on the advice of a health professional. Self-help techniques appear to be cost effective in terms of their minimal use of professionals. The popularity of hypnosis and acupuncture as quitting methods are not warranted by their quit rates. Quit rates can be improved if physicians provide more help to their patients than just simple advice and warnings.     

A smoking cessation intervention for the methadone-maintained

Aim To test, in combination with the nicotine patch, the incremental efficacy of a maximal, tailored behavioral treatment over a minimal treatment for smoking cessation. Design Randomized clinical trial with 6‐month follow‐up. Setting Five methadone maintenance treatment centers in Rhode Island. Participants Three hundred and eighty‐three methadone‐maintained smokers. Intervention Participants were assigned randomly to nicotine patch (8–12 weeks) plus either (1) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session and a relapse prevention follow‐up session (Max) or (2) brief advice using the National Cancer Institute's 4 As model (Min). An intent‐to‐treat analysis with those lost to follow‐up assumed to smoke was used. Measurements Carbon monoxide (CO)‐confirmed 7‐day point smoking cessation prevalence at 3 and 6 months, and self‐reported numbers of cigarettes smoked per day. Findings Participants had a mean age of 40 years, were 53% male, 78% Caucasian, smoked 26.7 (± 12.2) cigarettes/day and had a mean methadone dose of 95.5 mg. At 3 months, 317 (83%) were reinterviewed; at 6 months, 312 (82%) were reinterviewed. The intent‐to‐treat, 7‐day point prevalence estimate of cessation was 5.2% in the Max group and 4.7% in the Min group (P = 0.81) at 6 months. In logistic models with treatment condition, age, gender, race, Fagerström Test for Nicotine Dependence and cigarettes per day as covariates, males were more likely to be abstinent at 3 months (OR 4.67; P = 0.003) and 6 months (OR 4.01; P = 0.015). Conclusion A tailored behavioral intervention did not increase quit rates over patch and minimal treatment. Smoking cessation rates in methadone‐maintained smokers are low, with men having greater success.