In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.
Hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. Hypertension is common among patients with diabetes. Recently, the American Diabetes Association (ADA) published a new position statement which updated the assessment and treatment for hypertensive patients with diabetes. This interpretation is intended to help Chinese clinicians to understand the new ADA position statement.
Objective To summarize and analyze the working experience of hospital performance evaluation and reporting system in America, so as to provide decision support to China on such work as establishing objective, scientific and effective hospital performance evaluation system, strengthening government’s supervision to health service, and promoting hospitals’ sound development.Methods American official websites and databases were searched to include relative policies, reports and documents on hospitals’ performance evaluation. Results Typical hospital performance evaluation and reporting system in America included National Healthcare Quality Report (NHQR), Consumer Assessment of Healthcare Providers and System (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), Leapfrog Group Evaluation System and Thomson Reuters 100 Top Hospitals. Conclusion The enlightenments of American performance performance evaluation systems to China include: a) more attention should be paid to performance evaluation; b) combined evaluation models and results application methods should be considered; c) comparatively scientific evaluation methods and comprehensive evaluation contents should be established.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.
In November 2017, the American Heart Association updated the pediatric basic life support and cardiopulmonary resuscitation (CPR) quality. The new guidelines focused on the clinical value of chest compression-only CPR versus CPR using chest compressions with rescue breaths in children, rather than a comprehensive revision of the 2015 edition guidelines. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated part content of the guidelines according to the continuous evidence review process. Guidelines recommend CPR using chest compressions with rescue breaths should be provided for infants and children with cardiac arrest. Bystanders provide chest compressions if they are unwilling or unable to deliver rescue breaths. This article mainly interprets the updated content.
The management of malignant pleural effusion remains a clinical challenge. In November 2018, American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
With the publication of a vast amount of clinical research on hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases (AASLD), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the National Health Commission of China have all updated their diagnostic and treatment guidelines for HCC. There are no differences in the definition of HCC risk populations among the AASLD 2023, NCCN 2024, and China Liver Cancer Staging and Treatment Guideline (CNLC) 2024. Notably, CNLC 2024 has updated its guidance on high-risk factors and prospective surveillance for HCC based on the characteristics of HCC patients in China. The four guidelines have seen significant updates in the areas of neoadjuvant and adjuvant therapies, local treatments, and systemic treatments for HCC. CNLC 2024 refines the indications for local treatment, improves systemic treatment, and introduces new first-line therapy, including camrelizumab combined with rivoceranib or tislelizumab. The second-line therapy nivolumab plus ipilimumab for advanced HCC are recommended by AASLD 2023, NCCN 2024, and ASCO 2024, which may become a new first-line therapeutic option for patients with advanced HCC. We compare and interpret these four guidelines in this paper.
The American Heart Association (AHA) released the 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality (2017 AHA guidelines update) in November 2017. The 2017 AHA guidelines update was updated according to the rules named " the update of the guideline is no longer released every five years, but whenever new evidence is available” in the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The updated content in this guideline included five parts: dispatch-assisted cardiopulmonary resuscitation (CPR), bystander CPR, emergency medical services - delivered CRP, CRP for cardiac arrest, and chest compression - to - ventilation ratio. This review will interpret the 2017 AHA guidelines update in detail.
ObjectiveTo compare the citations of Chinese literature in the 2015 and 2025 editions of the American Thyroid Association (ATA) guidelines, aiming to evaluate the progress in the field of differentiated thyroid cancer (DTC) research in China. MethodsChinese literature cited in the 2015 and 2025 ATA guidelines was collected and cataloged. A comparison was conducted between the two editions regarding the number of publications, source journals, affiliated institutions and their regional distribution, research types, and research foci of the cited literature. Results ① Changes in the quantity and regional distribution of Chinese citations: in the 2025 ATA guideline, the proportion of Chinese literature cited increased by nearly two times compared to the 2015 ATA guideline [8.8% (128/1 458) vs. 3.3% (36/1 078), P＜0.001]. The number of source journals increased by nearly three times (74 vs. 21), the number of contributing cities nearly doubled (29 vs. 13), and the number of involved healthcare institutions increased by nearly three times (65 vs. 18). In terms of regional distribution, compared to the 2015 ATA guideline, where institutions producing cited literature were mainly located in the Taiwan region (11 publications), the Hong Kong region (11 publications), and coastal and Beijing-Tianjin-Hebei rigions of the Chinese mainland (12 publications), the 2025 ATA guideline showed a expansion of distribution to medical centers in regions such as Beijing-Tianjin-Hebei, Yangtze River Delta, Pearl River Delta, Chengdu, and Changchun. Among these, West China Hospital of Sichuan University had the highest number of cited publications nationwide (20 publications). The proportion of cited literature from institutions in the Chinese mainland increased significantly compared to that from the Taiwan and Hong Kong regions [69.2% (45/65) vs. 16.9% (11/65) and 13.8% (9/65)]. ② Changes in research types of cited literature: clinical research constituted the majority [100% (36/36) and 97.7% (125/128), respectively] of the cited Chinese literature in both the 2015 and 2025 ATA guidelines. However, three basic research studies appeared in the 2025 ATA guideline. Cited literature in both editions was predominantly single-center studies [86.7% (26/30) and 93.8% (90/96), respectively]. ③ Changes in research foci of cited literature: the number of research foci involved in the 2025 ATA guideline (19 foci) increased by nearly doubled compared to the 2015 ATA guideline (11 foci). Among them, iodine-131 therapy was the most cited research focus in both editions. Among research foci with ≥5 citations, besides traditional areas such as tumor staging and prognosis, and surgical methods and extent which remained top-ranked, the ranking of recurrent laryngeal nerve protection rose. The ranking of some traditional research foci, such as molecular markers, imaging, preoperative diagnosis, declined. Notable newly prominent or significantly changed foci included ablation therapy (12 publications, ranked 2nd), comprehensive treatment (11 publications), lymph node metastasis (10 publications), parathyroid protection (7 publications), thyroid cancer and pregnancy risks (5 publications), and active surveillance (5 publications). ConclusionsCompared to the 2015 ATA guideline, the 2025 ATA guideline cites a higher proportion of Chinese literature, demonstrates a wider geographical distribution of publication origins (expanding from Taiwan region, Hong Kong region, and coastal developed area to major regional centers across China), and covered broader and more in-depth research foci. This suggests that the field of DTC in China has undergone robust development in recent years, with a gradual shift from traditional focuses such as cure rate and recurrence rate towards improving long-term quality of life, developing individualized, and precise comprehensive management models. China is playing an increasingly important role in establishing global DTC diagnostic and treatment standards. However, high-quality prospective, multicenter, randomized controlled trials remain to be strengthened.
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.