In the context of the rapid development of contemporary medical industry and the unbalanced development of various subspecialties, expert consensus plays an extremely important role in guiding clinical practice and improving the quality of medical care. However, there are some deficiencies and limitations in the formation process and final report of the expert consensus. Therefore, this paper summarizes and reviews the definition, applications, and functions of expert consensus and the new progress of expert consensus formation methods by fully reviewing the literature, and puts forward the prospect. The purpose is to provide a reference for the production and application of expert consensus related to medical care, improve the outcomes of medical care, and upgrade the quality and level of medical services.
COVID-19 has been an established and continuing health problem. For the first time, this consensus focused on multi-scenario populations in the home/community, hospitalization and rehabilitation periods, and addressed medical nutrition management issues on which no consensus had yet been reached. This consensus was formulated on the basis of a comprehensive review of the existing evidence combined with the opinions of experts, with a view to complementing the existing guidelines/consensus.
The high incidence of hydatid disease in seven northwestern provinces, is one of the reason of "Poverty due to illness, and return poverty due to illness" in China. The incidence of chest hydatid disease in China after hepatic hydatid disease ranks second. Department of thoracic surgery in the First Affiliated Hospital of Xinjiang Medical University is on the domestic leading position of the treatment of chest hydatid disease. Since 1956 the first case of pulmonary hydatid cyst were completed, we have successfully finished the surgical treatment of pediatric chest hydatid disease, chest hydatid disease complex, huge pulmonary hydatid cyst, mediastinal and pleural hydatid cyst, and rib hydatid in our department. To further standardize the treatment of chest hydatid disease, a special formulation of "technical specification for chest hydatid disease diagnosis expert consensus" by our department were produced, in order to help clinicians treat chest hydatid disease by more suitable strategies. This consensus was released in July 2015, for the original version. The definition, diagnosis, treatment principle, and prevention of chest hydatid disease were elaborated and clinical experiences of 60 years were combined with in this consensus, in order to help the clinicians for diagnosis, treatment, and prevention of hydatid disease.
Clinical practice guidelines need to be based on evidence, but traditional Chinese medicine, especially integration of traditional Chinese and Western medicine guidelines, inevitably need to combine clinical research evidence, ancient literature, and expert experience and consensus. In the process of formulating, there are deviations in understanding and application of the expert consensus method and expert experience, resulting in opaque of the recommendations, unclear of the details of the diagnosis and treatment strategy, less prominent of the advantages and value of traditional Chinese medicine, which affects the scientificity, transparency, applicability, promotion and application of the guidelines of traditional Chinese medicine or integration of traditional Chinese and Western medicine. This study discusses the guiding principle of "evidence as a core, consensus as a supplement, and experience as a reference" that was generally followed and puts forward detailed methodological suggestions to the formulation of guidelines for traditional Chinese medicine and integration of traditional Chinese and Western medicine.
ObjectiveTo systematically investigate the current status of reporting health economics evidence in clinical practice guidelines and expert consensuses published in China from 2021 to 2023, providing references for the formulation and revision of guidelines and consensuses in our country. MethodsComputer searches were conducted in the CNKI, CBM, WanFang Data, China Academic Journals Full-text Database, PubMed, and Web of Science to collect clinical practice guidelines and expert consensuses published in China from 2021 to 2023. Two researchers independently screened the literature, extracted information on the inclusion of economic evidence in guidelines and consensuses, and then used quantitative analysis methods for description. ResultsA total of 4 236 relevant articles were included, of which 1 066 (25.17%) reported health economics evidence; 120 (11.26%) reported health economics evidence in the formation of recommendation opinions; 109 (10.23%) reported health economics evidence in the grading of evidence quality; 832 (78.05%) reported health economics evidence in the interpretation and explanation of recommendation opinions. ConclusionThe reporting rate of health economics evidence in clinical practice guidelines and expert consensuses published in China is not high. The reporting rate of health economics evidence in consensuses is lower than that in guidelines. It is recommended that during the formulation process of guidelines and consensuses, the application of health economics evidence should be further strengthened in aspects such as the formation of recommendation opinions, the grading of evidence quality, and the interpretation and explanation of recommendation opinions, in order to improve the scientific, rigorous, and applicability of clinical practice guidelines and expert consensuses, and to play the role of guidelines and consensuses in optimizing the allocation of health resources, improving clinical diagnosis and treatment effects, and enhancing the quality of medical care.
ObjectiveTo compare the recommended medicines of cardiovascular and cerebrovascular diseases guidelines, expert consensus, or diagnosis and treatment specifications with essential medicines from the 2023 World Health Organization Model List of Essential Medicines (WHO-EML) and the 2018 National Essential Medicine List (NEML) in differences and similarities. MethodsSix guideline websites and one association website including Guidelines International Network and National Guideline Clearinghouse, etc. were searched from inception to July 2023. The latest cardiovascular and cerebrovascular diseases guidelines, expert consensus, diagnosis and treatment specifications involving medicine treatment were included, and we extracted the data (year, title, target disease, authors and recommended medicines), and the statistical analysis of recommended medicines included in the WHO-EML and NEML was performed by Excel 2016. ResultsA total of 83 guidelines, expert consensus, and diagnosis and treatment specifications were included, covering cerebrovascular diseases, ischemic heart diseases, hypertensive diseases, chronic rheumatic heart diseases, diseases of arteries, arterioles and capillaries and other unspecified circulatory system disorders. They were issued from 2002 to 2023. Fifty-five (66.3%) were published in the past 5 years. For the 246 recommended medicines, they were divided into 14 categories according to the pharmacological effect. 27.2% (67/246) were included in WHO-EML and 32.9% (81/246) were included in NEML, among which 41 medicines were included both in WHO-EML and NEML, 40 in NEML only, 26 in WHO-EML only, and 139 in neither. The number of excluded medicines in antihypertensive medicines, lipid-regulating medicines and antiatherosclerotic medicines and anticoagulants exceeded 10. ConclusionThe number of cardiovascular and cerebrovascular disease guidelines, expert consensus, and diagnosis and treatment specifications recommended for WHO-EML and NEML is lower than 50%, and the coverage rate of NEML for cardiovascular and cerebrovascular disease guidelines recommended treatment medicines is higher than that of WHO-EML.
As a new treatment option after conventional corticosteroids and immunomodulatory drugs, biologics have been widely used in the clinical management of non-infectious uveitis in many countries due to their approved efficacy and safety. Anti-tumor necrosis factor-alpha monoclonal antibody is the most commonly used one. However, the guidance on its standardized application is lacking. The Ocular Immunology Group of Immunology and Rheumatology Academy in Cross-Straits Medicine Exchange Association compiled the Chinese expert consensus on treatment of non-infectious uveitis with anti-tumor necrosis factor-alpha monoclonal antibody. This evidence-based consensus is made according to the principle of consensus building and combines the clinical experience of the experts. Twelve recommendations are formatted on the application of Adalimumab and Infliximab. The interpretation of this consensus point will help improve the normative and effective application of anti-tumor necrosis factor-alpha monoclonal antibody in ophthalmologists, rheumatologists and immunologists.
Diabetic retinopathy is one of the microvascular complications of diabetes and a major cause of blindness in adults. Early screening is an effective way to reduce blindness caused by diabetic retinopathy. The diabetic retinopathy is one of the chronic retinal diseases highlighted in the “14th Five-Year” National Eye Health Plan (2021-2025). The establishment of effective and practical community screening model is a powerful guarantee to complete early screening. It is of great significance to standardize screening methods, screening personnel duties, equipment allocation, referral conditions and screening sustainability. Chinese fundus disease and related field experts developed the consensus through a serious, comprehensive, and complete discussion, to provide more reference for establishing a suitable community screening model of diabetic retinopathy and increasing the screening rate of diabetic retinopathy.
Peripherally inserted central catheter (PICC) is widely used as an intravenous therapy pathway, and catheter occlusion is one of the most common complications during the use of PICC. Catheter occlusion may lead to extubation or re-catheterization, which may generate prolonged hospital stay and increased medical costs, thus affecting the implementation of treatment and patient prognosis. The prevention and treatment of occlusion are of great significance. Daily maintenance and nursing operations should be complete, standardized and implemented in place. Evidence-based standard procedures should be established to meet the needs of clinical work. This consensus follows the methods and principles provided in the WHO guidelines formulation manual, and forms a systematic and standardized clinical practice process, including PICC patency assessment, catheter occlusion degree and type assessment, risk factor prevention, blockage management, etc. The purpose of this consensus is to reduce catheter-related complications, ensure the longevity of PICC and the safety of patient treatment.
Maculopathy caused by various fundus diseases in the late stage is a common cause of low vision. Medical technology is difficult to reverse the loss of macular function currently, so interventions that help improve the visual system, utilize residual visual function, and improve quality of life deserve attention. Damage to the fovea of the macula does not mean that the entire retinal function is impaired. There may be one or more retinal regions adjacent to the fovea that can serve as a fixation center. It is possible to form stable paracentral fixation, complete functional remodeling of the visual system, and effectively utilize residual visual function by taking appropriate training on these potential paracentral fixation points for most patients. In 2021, a clinical guideline has been published for low vision rehabilitation in China. In order to strengthen the precise management of diseases and develop a standard operating procedure for visual training specifically for patients with low vision due to macular disease, the National Clinical Research Center for Eye Diseases initiated and organized relevant domestic experts, utilizing the latest research experience at home and abroad, and through repeated discussions, this consensus (International Practice Guideline Registration Number: PREPARE-2023CN199) was formed as a reference for ophthalmologists, optometrists and rehabilitation physicians in their clinical research and practice.