Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
ObjectiveThis study aimed to revise the perioperative recovery scale for integrative medicine (PRSIM) based on item response theory (IRT). MethodsUnder the guidance of IRT, a total of 349 patient data collected during the development of the original version of PRSIM at Guangdong Provincial Hospital of Chinese Medicine were used. Principal component analysis was performed using SPSS 18.0 software to test the unidimensionality. The R language was utilized for parameter estimation, including discrimination coefficient, difficulty parameters and information content, as well as drawing item characteristic curves to assess item quality and estimate item functioning differences. A comprehensive screening process was carried out by combining expert consultations, patient evaluations, and discussions within a core group. ResultsThe degree of discrimination of all items ranged from ?0.535 to 2.195. The difficulty coefficient ranged from ?10.343 to 5.461, and the average information content of all items ranged from 0.043 to 1.075. Based on the criteria for parameter selection, nine items were retained. The results of expert consultations indicated the removal of 5 items and the modification of 7 items. After discussion within the core group, a final decision was made to remove 5 items. ConclusionBased on a synthesis of IRT and expert consultation feedback, and following discussions within the core group, a revised version comprising 15 items is retained and modified from the original 20 items.
Objective The basic terms of the technical specifications for case-control studies in the field of traditional Chinese medicine (TCM) are formed by expert consensus methods, in order to develop detailed texts of the technical specifications. Methods According to the process of international guidelines, a total of 44 experts participated in the Delphi survey. Results The three rounds of questionnaire response rates were 73.3%, 86.4%, and 86.8%, respectively. The experts' authority coefficients were 0.82, 0.85, and 0.86, respectively; and the expert opinion coordination coefficients were 0.356, 0.349, and 0.422, respectively. Expert enthusiasm, authority, opinion centralization, and degree of coordination were relatively high. There were many opinions raised in the expert consensuses on how to measure TCM syndrome, TCM constitution, the time point of measurement and the selection of new cases. Conclusion The case-control studies in TCM field should pay more attention to the characteristics of TCM. The draft of technical specification involves the study design and reporting, which can improve the methodological and reporting quality of case-control studies.