Interpretation of standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology / 中华实验眼科杂志

Sequencing technology has evolved rapidly with the advent of high-throughput next-generation sequencing (NGS). By adopting NGS, more and more ophthalmologists and medical institutions are now performing genetic testing for molecular diagnosis and genetic research in genetic ocular disorders.Genetic testing has gradually become an indispensable test item in the diagnosis and treatment of patients with monogenetic ocular diseases and has been accompanied by new challenges in sequence interpretation due to increased complexity.As we know, NGS can detect a large number of the genetic variation data.Without strict standards to distinguish pathogenic variation from many potential functional variations in the human genome, false positive judgments of causality may be accelerated, which may hind the application and promotion of genetic diagnosis in clinical diagnosis as well as the biological understanding of diseases.The American College of Medical Genetics and Genomics (ACMG) has developed guidances for the interpretation of sequence variants and the Chinese Branch of Genetic Counseling has organized some experts in the field of genetic compiled the Chinese version of the ACMG Standards and Guidelines, which is one of the reference bases to help us interpret genetic variation.This article interpreted the ACMG Standards and Guidelines in order to provide reference for Chinese ophthalmologists in the classification of genetic variation, determination of pathogenic variation, application in clinical diagnosis and related genetic research.

Interpretation of the clinical guideline for point-of-care ultrasonography in the neonatal intensive care unit in the United States / 中国当代儿科杂志

In December 2022, the American Academy of Pediatrics released a clinical guideline for point-of-care ultrasonography (POCUS) in the neonatal intensive care unit (NICU). The guideline outlined the development and current status of POCUS in the NICU, and summarized the key elements and implementation guidelines for successful implementation of POCUS in the NICU. This article provides an overview of the key points of the clinical guideline and analyzes the current status of POCUS in China, providing a reference for the implementation of POCUS in neonatal care in China.

Evaluation of methodological and reporting quality of domestic clinical guidelines for hyperuricemia / 中国中药杂志

This study aims to evaluate the methodological and reporting quality of diagnosis and treatment guidelines for hyperuricemia as well as the expert consensuses and promote the understanding and application of the diagnosis and treatment guidelines for hyperuricemia. With "hyperuricemia" "guidelines" "consensus" "recommendations" as the key words in titles, the authors searched for the published clinical guidelines on hyperuricemia in Chinese against CNKI, Wanfang, VIP, Medlive and the official website of the industry association. The retrieval time limit was until May 31, 2021. The appraisal of guidelines for research and evaluation Ⅱ(AGREEⅡ) and the reporting items for practice guidelines in health care(RIGHT) were employed to evaluate the methodological quality and reporting quality of 14 guidelines/consensuses included. The average scores of the guidelines/consensuses were 80.85%(48.61%-98.61%) for the domain of scope and purpose, 34.52%(0-69.44%) for the domain of stakeholder involvement, 35.53%(6.25%-92.19%) for the domain of rigor of development, 55.85%(23.61%-86.11%) for the domain of clarity of presentation, 26.19%(0-76.04%) for the domain of applicability, and 21.42%(0-50.00%) for the domain of editorial independence. Nine guidelines/consensuses were of medium overall quality with grade B recommendation, and five guidelines/consensuses were of poor quality with grade C recommendation. The RIGHT classified the fourteen guidelines/consensuses into one of high reporting quality, three of medium reporting quality, and ten of low reporting quality. The results of this study indicate that the standardization and rigor of the methodological quality and the reporting quality of the clinical guidelines/consensuses for hyperuricemia in China remain to be strengthened.

Interpretation of Clinical Guideline for Anti-vascular Endothelial Growth Factor Therapy of Retinopathy of Prematurity by Japanese Ophthalmological Society / 中华实验眼科杂志

Retinopathy of prematurity (ROP) is the leading cause of blindness in children worldwide.Intravitreal injection of anti-vascular endothelial growth factor (VEGF) has become a widely used first-line treatment for ROP in recent decade, but the anti-VEGF treatment of ROP is off-label in China, and the injection method and dosage are different from adults.In December 2020, the Clinical Guideline for Anti-vascular Endothelial Growth Factor Therapy of Retinopathy of Prematurity was released by the Japanese Ophthalmological Society, which is by far the only guideline for anti-VEGF treatment of ROP.Due to the ethnic similarity between Japanese and Chinese, this guideline is of high reference value to Chinese ROP clinical practice.This article introduced and interpreted the main information in the guideline to provide Chinese ophthalmologists references for the understanding, diagnosis and treatment of ROP.

Study on the medication rules of the Clinical Guidelines for Medical Records in the treatment of damp resistance spleen and stomach diseases / 国际中医中药杂志

Objective:To explore the thoughts and rules of Ye Tianshi’s medication in the treatment of damp-resistance spleen and stomach disease in the Clinical Guideline Medical Records. Methods:In the spleen and stomach-related diseases and dampness chapters of Clinical Guideline Medical Records, the medical cases selected in the spleen and stomach, disease syndrome ondampness were selected and entered into the Traditional Chinese Medicine Inheritance Assistance Platform System (V 2.5). The software was used to analyze the frequency, tastes, meridian, and for the association rules analysis and complex system entropy cluster analysis of medication. Results:A total of 162 prescriptions were included, involving 155 traditional Chinese medicines. The Poria, Magnoliae Officinalis Cortex, Citri Reticulatae Pericarpium, Atractylodis Macrocephalae Rhizoma, Alismatis Rhizoma, were used frequently. The Qi of medicationwere mainly warm, cold and flat, and the five tastes were mainly bitter, sweet and pungent, mainly belonging to the spleen, stomach and lung meridian. The core drugs in the associated network were Atractylodis Macrocephalae Rhizoma, Alismatis Rhizoma, Polyporus, Poria, Magnoliae Officinalis Cortex, Citri Reticulatae Pericarpium, Ginseng Radix et Rhizoma, Scutellariae Radix and Coptidis Rhizoma. In the analysis of the correlation between drugs, there are 106 combinations of 2 drugs, 19 combinations of 3 drugs, 1 combination of 4 drugs, and 15 drug pairs with a correlation coefficient greater than 0.03, such as " Cimicifugae Rhizoma- Puerariae Lobatae Radix" and " Atractylodis MacrocephalaeRhizoma- Cinnamomi Ramulus" , " Armeniacae Semen Amarum- Gardeniae Fructus" . Based on complex entropy clustering analysis, 5 pairs of core combinations were extracted, such as " Paeoniae Radix Alba- Coptidis Rhizoma- Nelumbinis Semen" and " Scutellariae Radix- Coptidis Rhizoma-Poria" , and 5 new prescription combinations were obtained, which had the effects of clearing heat and drying dampness, promoting Yang and surpassing dampness, regulating qi and removing dampness, warming yang and removing dampness, clearing heat and dampness. Conclusions:In Clinical Guideline Medical Records, Ye Tianshi stressed regulating Qi machine, eliminating and removing discharge in the treatment of spleen and stomach diseases with dampness resistance. He often used the treatment methods of dispersing lung and removing dampness, ascending Yang and surpassing dampness, conducting Qi and guiding dampness, aromatizing dampness, warming yang and removing dampness, relieving dampness with bitterness, reducing dampness, clearing heat and removing dampness.

Clinical Practice Guideline for Allergic Rhinitis Treatment with Acupuncture / 中国结合医学杂志

With reference to international guidelines for the development of tools-Grading of Recommendations Assessment, Development and Evaluation (GRADE) system approach and reasoning, this practice guideline has been drafted reflecting the characteristics of acupuncture to improve effectiveness and safety of acupuncture treatment for allergic rhinitis. This guideline includes outlining the acupuncture diagnosis and treatment principles for allergic rhinitis, suggesting recommendations and related evidence for the acupuncture treatment of allergic rhinitis, and defining operating methods and precautions for the acupuncture treatment of allergic rhinitis.

Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition) / 中国胸心血管外科临床杂志

@#Objective    The clinical trial evidence and expert consensus in the airway management were systematically summarized in this guideline to provide clinical guidance for healthcare professionals. Methods    A total of 40 clinical questions were proposed by 32 experts, and 12 clinical questions were finally identified through the Delphi method and the PICO (patient, intervention, control, outcome) principle from 2019 to 2020. PubMed, Web of Science, Wanfang database and CNKI were searched from establishment of each database up to November, 2020. The evidence of 160 articles was graded according to GRADE method, including 18 in class A, 36 in class B, 69 in class C, and 37 in class D. Four symposiums were organized for discussion of the recommendations. Finally, 23 recommendations were made for these 12 clinical questions, among which 10 were strongly recommended and 13 were weakly recommended. Results    Smoking cessation for at least 4 weeks, pulmonary function assessment and pulmonary rehabilitation exercise were recommended in the perioperative period, especially at least 1 week of pulmonary rehabilitation exercise for the patients with high risk factors. Anesthesia was maintained by inhalation or intravenous anesthesia. It was recommended to choose short acting drugs, monitor the depth of anesthesia and muscle relaxation during operation, and use protective ventilation strategy. Postoperative use of drugs and mechanical measures to prevent venous thromboembolism, the  appropriate application of drainage tube, preemptive analgesia and multimodal analgesia for pain management were recommended. Inhaled corticosteroids with bronchodilators could be used in perioperative period to reduce airway hyperresponsiveness and postoperative cough. Conclusion    For perioperative airway management, smoking cessation, pulmonary function assessment and pulmonary rehabilitation exercise are recommended in the perioperative period. The rational use of anesthetic drugs and protective ventilation strategy are emphasized during the operations. Postoperative pain management and cough treatment should be strengthened, and drainage tube should be used properly.

2017 American College of Cardiology/American Heart Association Clinical Guideline-based Prevalence of Hypertension in a semi-urban community in Nigeria: Public Health Perspective / Guía clínica de 2017 sobre prevalencia de hipertensión del American College of Cardiology/American Heart Association en una comunidad semi-urbana de Nigeria: Perspectiva de Salud Pública

Abstract Background: Evidence from previous studies has consistently revealed that patients develop target organ damage even with seemingly normal blood pressure thus informing the development of a new treatment guideline in 2017. The prevalence of hypertension in Nigeria ranges from 8-45%, however this is expected to change due to the new guideline. Thus, this study sought to estimate the prevalence of hypertension based on 2017 ACC/AHA clinical guidelines, and determine its associated factors. Methods: In this cross-sectional study a total of 296 participants were recruited with a simple random technique using a table of random numbers. Blood pressure, weight and height were measured and data was analysed with SPSS version 22. The primary outcome measures included proportion of respondents with hypertension based on AHA guideline and JNC 7 classifications, as well as the association between hypertension and BMI, age, sex and marital status. Results: The mean age of study participants was 38.71years, and male to female ratio was 2:3. Overall prevalence of hypertension was 63.5% and 22.6% based on the new guideline and JNC 7 classification respectively; higher risk of hypertension was significantly associated with the AHA guideline (p< 0.001). Association between body mass index, marital status (currently married/not married), sex, age group (≥40 vs. < 40years) and systolic as well as diastolic hypertension was significant (p< 0.001). Females were more than twice as likely to be hypertensive as males [OR: 2.51 (1.54 - 4.10)]. Age and weight were the only significant predictors of abnormal blood pressure, diastolic and systolic hypertension. Conclusion: Prevalence of hypertension based on the new guideline is staggeringly high and portends a huge public health problem. This conundrum requires immediate intervention in order to forestall the damaging effects of hypertension on vital body organs and for participants to lead a healthy life.

Resumen Antecedentes: La evidencia de los estudios previos ha revelado, consistentemente, que los pacientes desarrollan daños en los órganos diana aun cuando su presión arterial es aparentemente normal, lo cual ha impulsado el desarrollo de una nueva guía de tratamiento en 2017. La prevalencia de la hipertensión en Nigeria oscila del 8 al 45%, aunque está previsto que cambie, debido a esta nueva guía. En nuestro estudio calculamos la prevalencia de la hipertensión, basada en la guía clínica de ACC/AHA de 2017, y determinamos sus factores asociados. Métodos: En este estudio transversal reunimos a un total de 296 participantes mediante una técnica aleatoria simple, utilizando una tabla de números aleatorios. Medimos la presión arterial, el peso y la altura, y analizamos los datos con SPSS versión 22. Las medidas del resultado primario incluyeron la proporción de respondedores hipertensos, basándonos en la guía AHA y en la clasificación JNC 7, así como en la asociación entre hipertensión e IMC, edad, sexo y estado civil. Resultados: La edad media de los participantes del estudio fue de 38,71 años, siendo el ratio varón:mujer de 2:3. La prevalencia global de la hipertensión fue del 63,5% y del 22,6%, sobre la base de la nueva guía y la clasificación JNC 7, respectivamente. El mayor riesgo de hipertensión se asoció significativamente a la guía AHA (p< 0,001). La asociación entre índice de masa corporal, estado civil (actualmente casados/solteros), sexo, grupo de edad (≥40 vs. < 40 años), e hipertensión sistólica y diastólica fue significativa (p< 0,001). Las mujeres superaron en más del doble a los varones, en cuanto a la probabilidad de padecer hipertensión [OR: 2,51 (1,54 - 4,1)]. La edad y el peso constituyeron los únicos factores predictivos significativos de presión arterial anormal e hipertensión diastólica y sistólica. Conclusión: La prevalencia de la hipertensión basada en una nueva guía es asombrosamente elevada, presagiando un gran problema de salud pública. Este interrogante requiere una intervención inmediata, a fin de prevenir los efectos dañinos de la hipertensión en los órganos vitales, y animar a los participantes a llevar una vida sana.

Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte II: Guía clínica chilena de Prevención de Infecciones Asociadas al Uso de Terapias Biológicas (PREVITEB) / Consensus of infectious complications in patients treated with selected biological therapies. Screening of hepatitis B in high risk Chilean and immigrant pregnant women: Management of mother to child transmission Second part: Chilean Guidelines for Prevention of Infections associated to use of Biological Therapies (PREVITEB)

Resumen La incorporación de terapias biológicas ha significado un gran avance en el manejo de diversas patologías de origen autoinmune, neoplásico u otros. Si bien su uso ha implicado mejoras significativas en el pronóstico de estas enfermedades, no está exento de complicaciones, entre éstas, las infecciosas. El objetivo de este consenso fue evaluar el perfil de seguridad, desde la mirada infectológica, de las terapias biológicas de uso más frecuente y dar recomendaciones para la prevención de infecciones en pacientes tratados con ellas, basándose en la evidencia de mayor calidad disponible para los biológicos seleccionados. El consenso cuenta de dos manuscritos. Esta segunda parte corresponde a la guía clínica que detalla estas recomendaciones mediante estrategias de cribado, terapias profilácticas e indicación de vacunas, según corresponde, para infecciones bacterianas, y por micobacterias en particular, virus, hongos y parásitos, tanto para adultos como para niños.

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.

Formulation of the Scope and Key Questions of the Guideline Recommendations for Immunosuppressive Treatment in Kidney Transplantation

BACKGROUND: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. METHODS: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. RESULTS: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. CONCLUSION: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.

A qualitative study on the construction of clinical problems based on the guidelines of primary percutaneous coronary intervention nursing practice / 中国实用护理杂志

Objective@#To understand the working categories of primary percutaneous coronary intervention (PCI) nursing and its existing problems, and to provide a realistic basis for the construction of primary PCI in clinical nursing.@*Methods@#Qualitative interviews were used to carry out semi-structured and personal in-depth interviews among 5 doctors and 27 nurses in 5 hospitals. 7 step analysis of Colaizzi was used to analyze the data.@*Results@#The working categories of primary PCI nursing involves professional team management, early identification, preoperative preparation, evaluation and predictive nursing, disease observation, safe transfer, psychological nursing and health guidance.@*Conclusion@#Primary PCI nursing is still in the stage of continuous optimization, but some parts of the process are not standardized and the nursing behavior is inconsistent. Primary PCI nursing needs to form nursing behavior norms under the guidelines of evidence-based medicine.

Study on the Potential Drug Interaction in Clinical Guidelines for 9 Chronic Diseases / 中国药房

OBJECTIVE： To reduce ADEs due to potential drug interaction （short for drug interaction） by improving medical staffs’ recognition， and to provide reference for making clinical guidelines for chronic disease. METHODS：  According to the Survey Reprots on Chinese Resident’s Nutrition and Chronic Disease and related literatures， nine common chronic diseases （hypertension， type 2 diabetes mellitus， dyslipidemia， depression， primary lung cancer， rheumatoid arthritis， ischemic stroke， chronic heart failure and chronic obstructive pulmonary disease） and latest corresponding clinical guidelines， developed by the Chinese Medical Association or National Health and Family Planning Commission were selected to evaluate the improvement of drug interaction in the guidelines. Retrieving Micromedex， Stockley’s Drug Interactions， Medscape， Adverse drug interactions： A Handbook for prescribers and drug instructions， centered on the clinical guidelines for hypertension， type 2 diabetes and dyslipidemia， which were most likely to coexist with other chronic diseases and had the highest incidence， the number of drug interactions （mild/medium and severe drug interaction） of drugs recommended by 3 chronic disease guidelines and 8 other guidelines were counted， and drugs with a large number of severe drug interactions were also counted. RESULTS： There was no guideline to discussing the interaction between recommended drugs for comorbidity. The number of mild/mediuem drug reactions recommended by clinical guidelines for hypertension， type 2 diabetes， dyslipidemia and other 8 disease were 759， 681 and 68， respectively； those of severe drug interaction were 262， 17 and 37， respectively. The drugs with a high number of severe drug interactions were digoxin （24）， aspirin （22）， diuretics （12 kinds of drugs， 14-17）. CONCLUSIONS： When patients suffer from multiple chronic diseases， clinical pharmacists should pay attention to drug interactions. Selected clinical guidelines for chronic diseases still need to be completed the content of drug interactions.

A qualitative study on the construction of clinical problems based on the guidelines of primary percutaneous coronary intervention nursing practice / 中国实用护理杂志

Objective To understand the working categories of primary percutaneous coronary intervention (PCI) nursing and its existing problems, and to provide a realistic basis for the construction of primary PCI in clinical nursing. Methods Qualitative interviews were used to carry out semi-structured and personal in-depth interviews among 5 doctors and 27 nurses in 5 hospitals. 7 step analysis of Colaizzi was used to analyze the data. Results The working categories of primary PCI nursing involves professional team management, early identification, preoperative preparation, evaluation and predictive nursing, disease observation, safe transfer, psychological nursing and health guidance. Conclusion Primary PCI nursing is still in the stage of continuous optimization, but some parts of the process are not standardized and the nursing behavior is inconsistent. Primary PCI nursing needs to form nursing behavior norms under the guidelines of evidence-based medicine.

Interpretation and prospect of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis / 中国中药杂志

Clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis is strictly in accordance with the latest diagnostic criteria for sepsis (sepsis-3) for the treatment of septic patients at different stages through syndrome differentiation. At present, the abuse of antibiotics and the prevalence of drug-resistant bacteria are very serious, without effective solutions. Thus, this is the first time to focus on traditional Chinese medicine combined with antibiotics to treat sepsis, in order to minimize the incidence of drug-resistant bacteria. This Guideline tends to systematically analyze the sepsis period, septic shock period as well as different clinical symptoms and traditional Chinese medicine measures for organ dysfunction in the sepsis process. By analyzing and interpreting the Guideline systematically, the clinicians could understand its purpose, significance and core ideas more thoroughly, and grasp the recommended specific interventions as well as their advantages and disadvantages, hoping to better implement the Guideline, provide guidance to clinicians and standardize the treatment of sepsis by traditional Chinese medicine.

Evidence-based Evaluation of Global Existed Diarrhea Guidelines of Children / 中国药房

OBJECTIVE:To evaluate the global existed diarrhea guidelines of children,and provide evidence and methodology reference for clinical practice and the formulation of diarrhea evidence-based guideline of children in China. METHODS:Retrieved from PubMed,Embase,CBM,CNKI,VIP,Wanfang databases and related websites,references included in studies were retrieved additionally from database building to Dec. 2017. The methodological quality of the guideline was evaluated by 2 researchers independently with guideline evaluation toolⅡ(AGREEⅡ). ICC analysis was used to calculate the differences between the evaluation results of 2 researchers and analyze the difference of the guidelines. RESULTS:A total of 1 168 literatures were collected primarily, and 15 guidelines were involved finally,among which 3 guidelines were from USA,2 from British,2 from WHO,each one from Italy,Europe,India,Australia,Malaysia,New South Wales,South Africa and China,respectively. Of 15 guidelines,there were 10 evidence-based guidelines and 5 non-evidence-based guidelines;evidence levels of guidelines and the method of recommendation intensity were different. ICC of 2 researchers were higher than 0.75(P<0.05),indicating good homogeneity among them. The quality of 15 guidelines were not high enough,and the scores of included guidelines in the field of AGREEⅡin descending order were as follows:scope and purpose(84.44%),clarity of presentation(79.82%),stakeholder involvement(45.74%), rigor of development(41.18%), editorial independence (36.39%)and applicability(33.89%). Main prevention and treatment method recommended by guideline included that(1) prevention and treatment of dehydration was the key link in the treatment of children's diarrhea;(2)guidelines generally believed continuous breastfeeding during rehydration could reduce the risk of dehydration in children;(3)zinc preparation was recommended to shorten the course of diarrhea;(4)antibiotics were used rationally, etc. CONCLUSIONS:The quality of global existed diarrhea guidelines of children should be improved. There is no comprehensive diarrhea evidence- based guideline of children in China,and there is a large discrepancy between the situation of pediatric diarrhea therapy in China and WHO standard;it is urgent to establish a standard treatment. It is suggested to formulate high quality pediatric diarrhea guideline in accordance with the national conditions of China,based on standards for international guideline report, comprehensively considering disease burden and characteristics of pediatric diarrhea in China.

Status quo of knowledge expression model of clinical guidelines / 中华医学图书情报杂志

Clinical guidelines,coming into being with the development of evidence-based medicine,are of great significance in reducing medical malpractice and regulating medical behaviors.However,more effective and intelligent measures should be taken for their development and application due to their low utilization and poor compliance of doctors in their implementation.The emergence and structure of clinical guidelines were elaborated with related problems summarized.The knowledge expression models of digital clinical guidelines were analyzed and compared with the challenges faced by the current knowledge expression models of clinical guidelines pointed out.

Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.

Clinical Guidelines for the Management of Adrenal Incidentaloma

An adrenal incidentaloma is an adrenal mass found in an imaging study performed for other reasons unrelated to adrenal disease and often accompanied by obesity, diabetes, or hypertension. The prevalence and incidence of adrenal incidentaloma increase with age and are also expected to rise due to the rapid development of imaging technology and frequent imaging studies. The Korean Endocrine Society is promoting an appropriate practice guideline to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues in managing the patients with adrenal incidentaloma. After evaluating core proposition, we propose the most critical 20 recommendations from the initially organized 47 recommendations by Delphi technique.

Indicaciones de TAC de cráneo simple en pacientes menores de 2 años con trauma encefalocraneano leve / Indications for head computed tomography in patients younger than 2 years old with minor head injuries

Resumen Existe gran variabilidad en la práctica clínica en cuanto al uso de estudios imagenológicos, específicamente de la tomografía de cráneo simple en los casos de trauma encefalocraneano leve, más aun en pacientes menores de 2 años. En la mayoría de estos pacientes existe bajo riesgo de injuria intracraneal, sin embargo, este grupo etario plantea mayores retos diagnósticos por las dificultades en su evaluación y las pocas manifestaciones clínicas que podrían presentar dado a sus características anatómicas. Resulta necesario acogerse a las guías de práctica clínica que contengan reglas de decisión clínicas, que incluyan los signos y/o síntomas con mayor valor predictivo para detectar injuria intracraneal, costo efectivas y redundando en el beneficio del paciente.

Summary There is great variability in clinical practice with the use of imaging studies, specifically head computed tomography in cases of minor head injuries, even more so in patients younger than 2 years old. Most of these patients have low risk of intracranial injury; however, this age group represents greater challenges in the diagnosis, because of the difficulties in their assessment and lack of clinical results that could be present due to their anatomical characteristics. It is necessary to make clinical practice guidelines that include some key points like clinical signs and/or symptoms with greater predictive value for detecting intracranial injury, cost-effective interventions resulting in benefits for the patients.

Guía clínica: lupus eritematoso sistémico (LES) / Systemic lupus erythematosus: a clinical guide

El Lupus Eritematoso Sistémico (LES) es una enfermedad inflamatoria, sistémica, crónica, de patogenia autoinmune. Sus manifestaciones varían desde afecciones leves a graves o fatales. En más común en mujeres y su prevalencia varía entre 40 a 200 casos/100.000 habitantes. El diagnóstico y reconocimiento precoz de sus manifestaciones sistémicas son críticos para una adecuada derivación, tratamiento y pronóstico de los pacientes. A petición del MINSAL, la Sociedad Chilena de Reumatología designó un grupo de trabajo para la elaboración de una guía clínica de LES. Objetivos: Definir niveles de atención, criterios de derivación según gravedad y elaborar recomendaciones para el diagnóstico, tratamiento y seguimiento de los principales compromisos del LES siguiendo la metodología de realización de guías clínicas. Metodología: Se siguieron las indicaciones para realización de guías clínicas basadas en criterios de evaluación (AGREE) y una combinación de criterios de medicina basada en la evidencia y consenso de expertos. La pesquisa bibliográfica se centró en la búsqueda de respuesta para 13 preguntas seleccionadas, respecto a: niveles de atención y criterios de derivación; abordaje general; principales compromisos graves del LES y situaciones especiales. Para cada pregunta se hizo una recomendación. La evidencia se estableció usando una escala tradicional. Además, se midió el grado de acuerdo (GdA) con las recomendaciones efectuadas, mediante una escala de 0 a 10 puntos, por los reumatólogos integrantes del grupo de trabajo y por cinco pares independientes. Resultados: Se desarrollaron 13 recomendaciones respecto a: 1) Rol del médico no especialista y criterios de derivación. 2) Rol del reumatólogo. 3) Sospecha y diagnóstico precoz del LES. 4) Pronóstico y gravedad. 5) Evaluación de actividad y daño en el LES. 6) Patología asociada al LES. 7) Fármacos utilizados en el LES y su toxicidad. 8) Bases diagnósticas de nefropatía lúpica. 9) Tratamiento de nefropatía lúpica...

Systemic lupus erythematosus (SLE) is an inflammatory, systemic and chronic disease of autoimmune pathogenesis. Manifestations vary from mild to serious or fatal conditions. It is most common among women and its prevalence varies between 40 to 200 cases/100.000 inhabitants. Early diagnosis as well as identification of systemic manifestations are critical for adequate referral, treatment and prognosis. At the request of Chile's health ministry, the Chilean Society of Rheumatology designated a work group to elaborate clinical guidelines for SLE. Objectives: Define levels of attention, criteria for referral according to seriousness, and elaborate recommendations for diagnosis, treatment and follow-up of the main disorders of SLE following the clinical guideline execution methodology. Methodology: Indications for the creation of clinical guidelines based on the AGREE evaluation criteria and a combination of medical criteria based on expert evidence and consensus were followed. Bibliographical investigation was centered on responding 13 selected questions with respect to: level of attention and referral criteria; general approach; main critical SLE compromises, and special situations. A recommendation was given for each question. Evidence was established using a traditional scale. Moreover, the degree of agreement was measured (GdA) with the recommendations carried out, by means of a scale from 0 to 10 by the rheumatologists who made up the work group and by five independent peers. Results: 13 recommendations were developed with respect to: 1) Role played by non-specialized physicians and referral criteria; 2) Role played by rheumatologist; 3) Suspicion and early diagnosis of SLE; 4) Prognosis and seriousness; 5) evaluation of SLE activity and damage; 6) Pathology associated to SLE; 7) Drugs used for SLE and their toxicity; 8) Diagnostic basis for lupus nephritis; 9) Treatment for lupus nephritis; 10) Neuropsychiatric manifestations of SLE; 11) SLE and...