Differences in Contents and Formation Methods of Clinical Questions in Chinese and Korean Clinical Practice Guidelines of Acupuncture-Moxibustion: Scoping Review.

OBJECTIVE: To analyze the differences in the needs of users and the value orientation of clinical practice guidelines (CPGs) by comparing the contents and formation methods of clinical questions in Chinese and Korean CPGs of acupuncture-moxibustion (Acup-Mox). METHODS: The full text of CPGs was systematically searched from the official websites of Chinese and Korean traditional medicine societies and Acup-Mox associations, with the topic "Acup-Mox for treating diseases" and the retrieval time up to September 28, 2022. Two researchers screened the CPGs independently, and extracted the guidelines' topics, content, quantity and formation methods of clinical questions. The quantitative data were collected by counting the frequency, and the qualitative data were classified and described by thematic analysis. RESULTS: A total of 29 guidelines were included in this study, including 20 Chinese guidelines (305 questions) and 9 Korean guidelines (223 questions). The differences lie in the aspects of content and diversity, and formation method. As for content and diversity, Chinese guidelines focused mainly on the questions related to treatment such as the operation of specific intervention (86, 28.2%), efficacy of intervention (78, 25.6%), and also involving questions in diagnosis, prevention, and prognosis. While the clinical questions in Korean guidelines were concentrated to efficacy of intervention (218, 97.8%). As for formation method, in Chinese guidelines, questions were usually collected directly from clinicians, and then determined and optimized by experts. In Korean guidelines, frequently used clinical Acup-Mox interventions would be screened first. Then the expert group would set up corresponding intervention control measures so as to form clinical questions related to treatment efficacy. CONCLUSIONS: The differences reflect the different needs of clinical practitioners, and the different aims or concepts in developing Acup-Mox guidelines between China and South Korea. Chinese guidelines emphasized promoting operation protocols and techniques of Acup-Mox for practical use, while Korean guidelines emphasized promoting the frequently used clinical intervention therapies. It is speculated that the guidelines from these two countries would play different roles in guiding clinical operation and supporting medical decision. In terms of formation methods of clinical questions, it is suggested to attach importance to optimizing process in formatting clinical questions to improve the clinical applicability of CPGs of Acup-Mox.

Discussion on Collection of Clinical Questions in International Clinical Practice Guidelines of Acupuncture-Moxibustion.

The clinical questions of acupuncture-moxibustion (Acup-Mox) guidelines are complicated, including not only the curative effect of Acup-Mox intervention measures, but also the operational elements of Acup-Mox. This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines. The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions. Based on the characteristics of Acup-Mox discipline. This paper put forward the thinking of collecting elements of clinical questions following the intervention-population-outcome-control (I-P-O-C) inquiry process, according to the discipline of Acup-Mox. It was emphasized that in the process of collecting clinical questions, "treatable population" and "alleviable outcome indicators" for a specific Acup-Mox intervention with certain therapeutic effect should be focused on, so as to highlight the pertinence of clinical questions of Acup-Mox guidelines in terms of population and outcome elements.

[Analysis and thought on reaching the consensus during the development of acupuncture and moxibustion clinical practice guidelines in China].

Based on the 28 Chinese clinical practice guidelines of acupuncture and moxibustion, this study summarized and analyzed the contents related to reaching consensus during the development process. The results indicated that all the 28 guidelines reported they have used consensus in the "recommendations" section, and provided details on consensus personnel, consensus methods, consensus process and consensus materials. However, it was found that the reporting of consensus was in need of further improvement. The limitations included unclear definition and responsibilities of "expert group", obscure concept between "consensus meeting" and "expert discussion", non-rigorous process of reaching consensus when generating recommendations and lacking of detailed reporting of the consensus reaching process. As such, we suggested that future researchers should conduct researches to further standardized the consensus process when developing acupuncture and moxibustion clinical practice guidelines, so as to improve the quality and clinical applicability of guidelines．.

[Investigation and analysis on the current situation of clinical practice guidelines for acupuncture and moxibustion at home and abroad].

To provide directional suggestions for the establishment of international clinical practice guidelines for acupuncture and moxibustion by investigating the current situation of clinical practice guidelines for acupuncture and moxibustion at home and abroad. The clinical practice guidelines were obtained by questionnaire survey, database retrieval and experts consulting. The guidelines were read carefully, and the content was analyzed. A total of 27 acupuncture-moxibustion clinical practice guidelines were retrieved, of which most of the guidelines came from China. The definition and scope of "acupuncture and moxibustion "vary according to different guidelines; and the focus of the content and the method of establishing the guidelines are quite different, so it is very necessary to unify the formulation methods of acupuncture-moxibustion clinical practice guidelines. Chinese clinical practice guidelines for acupuncture and moxibustion were characterized by taking the ancient literature as the evidence. Excavating the value of ancient literature and clinical experience of acupuncture-moxibustion experts are the key points and difficulties in the developing of clinical practice guidelines of acupuncture and moxibustion in the future.

[Consideration on existing problems in development of clinical practice guidelines for acupuncture and moxibustion in China].

To sort out the existing problems within the published 35 evidence-based acupuncture-moxibustion clinical practice guidelines (group standards) in Chinese: the development methods and the development process are not clear and strict enough; the evidence evaluation system fails to fully reflect the characteristics of acupuncture and moxibustion. Therefore, Norms for Formulation and Evaluation of the Guidelines on Clinical Practice of Acupuncture-Moxibustion, should require the guideline developers to consider the characteristics of acupuncture discipline, evaluate modern literature evidence comprehensively, and integrate ancient literature and medical experts' experience, to form proper recommendations for clinical practice. Specific requirements should be made simultaneously in the development process to make it clearer and stricter.

[Exploration on Whether to Standardize Acu-moxibustion].

Acu-moxibustion is the important component and inseparable in Chinese medicine with its unique characteristics. Just due to the distinct characteristics of acu-moxibustion, whether to standardize acu-moxibustion has been highlighted among the people in consideration of its development. In the present paper, the author introduces the characteristics of acu-moxibustion, the existence situation of its characteristics after being standardized, and the function, substance, feasibility, practice and effect, plan and strategy of acu-moxibustion standardization.

[Evolution of Classification Methods and Nomenclature of Clinical Disorders Treated by Acupuncture and Moxibustion in the 20th Century].

Through systematic review of the literature on the treatment of different clinical conditions or illnesses with acupuncture and moxibustion therapies in the 20th century, the authors of the present paper analyzed the evolution process of classification of related clinical disorders. It was found that the classification and nomenclature of clinical disorders or illnesses are defined in terms of traditional Chinese medicine or western medicine, which undergoes an evolutionary process from western medicine to Chinese medicine and back to western medicine. This evolution process is due to the intrinsic requirement' of clinical practice such as thinking ways of diagnosis and treatment or to be influenced by extrinsic factors including introduction of western medicine at the Republic period, policies of"advanced studies of traditional Chinese physcians" and "western medicine doctors" lear-ning from traditional Chinese medicine, and the leading role of western medicine,etc. The former issue about the diagnosis and treatment of clinical problems needs being researched further.

[Principles and Methods for Formulating National Standards of "Regulations of Acupuncture-nee- dle Manipulating techniques"].

The national standard of "Regulations of Acupuncture-needle Manipulating Techniques" is one of the national Criteria of Acupuncturology for which a total of 22 items have been already established. In the process of formulation, a series of common and specific problems have been met. In the present paper, the authors expound these problems from 3 aspects, namely principles for formulation, methods for formulating criteria, and considerations about some problems. The formulating principles include selection and regulations of principles for technique classification and technique-related key factors. The main methods for formulating criteria are 1) taking the literature as the theoretical foundation, 2) taking the clinical practice as the supporting evidence, and 3) taking the expounded suggestions or conclusions through peer review.

[On the necessity of intellectual property rights involving standardization of acupuncture and moxibustion therapies].

In the process of working out and implementing standardization of acupuncture-moxibustion (acu-moxi) therapy, the issue of intellectual property rights has been frequently involved. Whether is the standardization inevitably involved in intellectual property rights? A reasonable answer to this question is definitely of important realistic guiding value and significance for acu-moxi standardization work. For this reason, authors of the present paper sum up historical development of correlation between acu-moxi standardization and intellectual property rights, and fully analyze the related causes under the conditions of knowledge economy from 1) increasing protection of acu-moxi intellectual property rights, 2) intrinsic requirements for raising the standardization level of acu-moxi, 3) profits drive of the intellectual property rights owners, and 4) increasing impetuous international economic trade competition.

[Research on basic questions of intellectual property rights of acupuncture and moxibustion].

Along with the modernization and internationalization of acupuncture-moxibustion (acu-moxibustion), the issue of intellectual property rights has been becoming prominent and remarkable increasingly. In the present paper, the authors explain the basic issues of acu-moxibustion learning from the concept, scope, subject, object, contents and acquisition way of intellectual property rights. To make clear these questions will help us inherit and carry forward the existing civilization achievements of acu-moxibustion, and unceasingly bring forth new ideas and further improvement in clinical application, so as to serve the people's health in a better way.