Expert Consensus

专家共识
  • 文章类型: English Abstract
    Perioperative pulmonary rehabilitation may effectively reduce the incidence of postoperative pulmonary complications and improve the quality of life of lung cancer patients and its clinical application value in lung cancer patients has been widely recognized. However, there is still no international consensus or guideline for pulmonary rehabilitation regimen, lacking standardized criteria when pulmonary rehabilitation applied in perioperative clinical practice for lung cancer. The consensus provides implementation regimen and process of pulmonary rehabilitation, aiming to promote the reasonable and standardized application of perioperative pulmonary rehabilitation training in clinical practice, sequentially enable patients to maximize benefits from the rehabilitation.
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    【中文题目:肺癌围手术期肺康复训练中国专家共识】 【中文摘要:围手术期肺康复能有效降低术后肺部相关并发症的发生并提高肺癌患者术后的生活质量,在肺癌患者中的临床应用价值已被广泛认可。然而肺康复方案仍然没有形成国际共识和指南,运用于肺癌围手术期临床实践时缺乏规范和标准。本共识将通过提供围手术期肺康复训练的实施方案、流程,促进围手术期肺康复训练在临床实践中更合理、更规范地应用,最终能够使患者最大程度地从中获益。
】 【中文关键词:肺肿瘤;围手术期肺康复;专家共识】.
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  • 文章类型: Journal Article
    三尖瓣反流(TR)可能在左侧瓣膜手术(LSVS)后晚期发生。左侧瓣膜手术后孤立的三尖瓣返流(iTR-LSVS)是指在二尖瓣和/或主动脉置换或修复后后期在二尖瓣和/或主动脉位置没有明显病变的孤立TR。严重的TR对长期预后有负面影响,需要手术或经导管治疗。然而,在目前的瓣膜性心脏病治疗指南中,对于iTR-LSVS患者何时以及如何进行干预没有明确的建议.目前的微创技术和经导管治疗可以降低历史上较高的手术死亡率。为了进一步了解iTR-LSVS,规范治疗,改善预后,促进合作,中国微创心血管外科委员会(CMICS)撰写了这份专家共识,从病因学方面对iTR-LSVS进行管理,术前评估,干预的迹象,手术治疗,经导管治疗,和术后管理。
    Tricuspid regurgitation (TR) may occur late after left-sided valve surgery (LSVS). Isolated tricuspid regurgitation after left-sided valve surgery (iTR-LSVS) refers to isolated TR without significant lesions in the mitral and/or aortic position late after mitral and/or aortic replacement or repair. Severe TR has a negative impact on long-term prognosis and requires surgical or transcatheter treatment. However, there is no clear recommendation on when and how intervention should be performed for patients with iTR-LSVS in the current guidelines for the management of valvular heart disease. The historically high operative mortality may be reduced by current minimally invasive techniques and transcatheter therapy. To further understand iTR-LSVS, standardize the treatment, improve the prognosis, and promote the collaboration, the Chinese Minimally Invasive Cardiovascular Surgery Committee (CMICS) wrote this expert consensus on the management of iTR-LSVS from the aspects of etiology, preoperative evaluation, indications for intervention, surgical treatment, transcatheter therapy, and postoperative management.
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  • 文章类型: English Abstract
    To alleviate the medical burden of lung cancer surgery and facilitate the implementation of the national hierarchical diagnosis and treatment policy, it is imperative to establish a hierarchical diagnosis and treatment system for day surgery of lung cancer. Identifying key quality control checkpoints in day surgery of lung cancer is essential to enhance medical quality, ensure safety, and improve the efficiency of medical services. These efforts aim to uphold a safe and well-structured progression of day surgery practices in China. The Chinese Expert Consensus Group on Day Surgery Management of Lung Cancer has convened national experts in relevant fields and integrated the latest research findings from both domestic and international sources to craft the Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition). This consensus is founded on the principles of holistic management of lung cancer surgery and comprehensive patient care throughout their medical journey. It encompasses preoperative assessments, anesthesia protocols, surgical procedures, postoperative care, hospital-community collaboration initiatives, and emergency response strategies. The primary objective of this expert consensus is to furnish research assistance and clinical recommendations to advance the practice of day surgery for lung cancer patients in China.
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    【中文题目:肺癌手术日间化管理中国专家共识
(2024年版)】 【中文摘要:为高效利用有限的手术资源以缓解肺癌手术的医疗压力、促进国家分级诊疗政策的进一步落实,急需构建肺癌日间手术分级诊疗体系。肺癌日间手术各节点的关键质控有助于提升医疗质量安全与医疗服务效率,促进我国日间手术保持安全有序的良性发展。肺癌手术日间化管理中国专家共识小组凝聚了国内相关领域专家,结合国内外相关专业最新研究成果,基于肺癌日间手术全周期管理视角与患者全生命周期管理视角制定《肺癌手术日间化管理中国专家共识(2024年版)》。该共识主要从术前评估、麻醉管理、手术操作、术后随访、医院-社区一体化构建和应急管理等方面形成共识性意见,旨在为我国肺癌日间手术的开展提供研究支撑和临床指导。 
】 【中文关键词:肺肿瘤;外科;日间手术;医院管理;专家共识】.
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  • 文章类型: English Abstract
    Establishing enteral nutrition after the birth of preterm infants presents numerous challenges, particularly for those in special situations. Various disease factors and medical interventions impede the establishment of enteral feeding, leading to conflicts and controversies regarding feeding goals, feeding methods, and the challenges and solutions faced by these infants. A critical issue for clinical physicians is how to safely and promptly establish enteral nutrition to achieve full enteral feeding as quickly as possible. The consensus formulation working group, based on both domestic and overseas research, adopted the Grading of Recommendations Assessment, Development and Evaluation, and formed an expert consensus on enteral nutrition management for preterm infants in special situations. This consensus provides 14 recommendations for 9 common special situations, aiming to offer guidance on enteral nutrition management for preterm infants to improve their short and long-term outcomes. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 665-676.
    早产儿出生后肠内营养的建立面临诸多挑战,尤其是存在一些特殊情况的早产儿,由于多种疾病因素和医疗干预妨碍肠内喂养的建立,造成这些早产儿的喂养目标、喂养的方式方法以及所面临的各种问题和解决方案充满了矛盾和争议。如何在保证安全的前提下,尽早建立肠内营养,尽快地达到全肠内喂养,是临床医师亟需解决的问题。该共识制订工作组基于国内外相关研究,采用证据推荐分级的评估、制订与评价方法(Grading of Recommendations Assessment, Development and Evaluation),形成了特殊情况的早产儿肠内营养管理专家共识,针对临床常见的9种特殊情况提出了14条推荐意见,旨在为相关从业人员提供特殊情况的早产儿肠内营养管理的建议,以改善这些早产儿的近远期预后。.
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  • 文章类型: Journal Article
    重大创伤中心(MTC)护理与改善受伤患者的预后有关。英国的救护车服务和创伤网络目前使用一系列分诊工具来选择患者旁路到MTC。标准化的国家分诊工具可以提高分诊准确性,成本效益和决策的可重复性。
    我们进行了专家共识过程,以得出和开发一种主要的创伤分类工具,用于英国创伤网络。进行了基于网络的Delphi调查,以识别和确认主要创伤的候选分诊工具预测因子。召开了促进圆桌共识会议,以确认拟议的分类工具的目的,目标诊断阈值,范围,预期的人口和结构,以及个人分诊工具的预测因子和切点。举行了公众和患者参与(PPI)焦点小组,以确保分诊工具对服务用户的可接受性。
    Delphi调查就两个领域的9个分类变量达成共识,三轮后,从109个候选变量中提取。在协商一致会议期间对相关证据进行审查后,反复的讨论在分诊工具的以下方面达成了共识:参考标准,范围,目标诊断准确性和预期人群。包括生理学的三步工具,解剖损伤和临床判断领域,平行评估分诊变量,被推荐。分诊工具受到PPI焦点小组的好评。
    本文提出了一种新的专家共识得出的主要创伤分诊工具,具有明确的目的,范围,预期人口,结构,组成变量,变量定义和阈值。需要进行前瞻性评估以确定临床和成本效益,可接受性和可用性。
    UNASSIGNED: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making.
    UNASSIGNED: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool\'s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users.
    UNASSIGNED: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups.
    UNASSIGNED: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.
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  • 文章类型: Journal Article
    异种移植的历史始于19世纪。经过几十年的调查,在全球范围内取得了重大突破和临床前里程碑。随着最近将转基因猪的肾脏和心脏移植到人类体内,这些开创性的成就引起了全世界的极大关注,希望异种移植可以缓解甚至解决器官短缺的问题。2022年1月20日,中国器官移植发展基金会召开了“历史,人类异种移植临床试验的现状和未来,“与会专家讨论了促进中国异种移植伦理和可持续发展的方法。作为专题讨论会的产物,达成了正式的共识,概述专家对科学的意见,监管,中国异种移植临床试验的伦理问题。
    The history of xenotransplantation started in the 19th century. After a few decades of investigation, significant breakthroughs and preclinical milestones have been achieved worldwide. With the recent transplantation of genetically modified porcine kidneys and heart into humans, these ground-breaking achievements have attracted great attention worldwide, in the hope that xenotransplantation might alleviate or even solve the problem of organ shortage. On January 20, 2022, the China Organ Transplantation Development Foundation convened a symposium on \"The History, Current Situation and Future of Human Xenotransplantation Clinical Trials,\" where ways to promote the ethical and sustainable development of xenotransplantation in China were discussed among the participating experts. A formal consensus was reached as the product of the symposium, outlining the expert opinions on scientific, regulatory, and ethical issues of clinical trials of xenotransplantation in China.
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  • 文章类型: English Abstract
    Providing adequate and balanced nutrition for preterm infants, especially extremely/very preterm infants, is the material basis for promoting their normal growth and development and improving long-term prognosis. Enteral nutrition is the best way to feed preterm infants. Previous systematic reviews have shown that using evidence-based standardized feeding management strategies can effectively promote the establishment of full enteral feeding, reduce the duration of parenteral nutrition, improve the nutritional outcomes of preterm infants, and not increase the risk of necrotizing enterocolitis or death. Based on relevant research in China and overseas, the consensus working group has developed 20 recommendations in 5 aspects including the goal of enteral nutrition, transitioning to enteral nutrition, stable growth period enteral nutrition, supplementation of special nutrients, and monitoring of enteral nutrition for preterm infants, using the Grading of Recommendations Assessment, Development and Evaluation. The aim is to provide recommendations for healthcare professionals involved in the management of enteral nutrition for preterm infants, in order to improve the clinical outcomes of preterm infants.
    为早产儿尤其是极/超早产儿提供充足和均衡的营养是促进其正常生长发育和改善远期预后的物质基础,肠内营养是最佳的营养方式。既往系统回顾性分析显示使用基于循证医学的标准化喂养管理策略可有效促进全肠内喂养的建立,缩短肠外营养时间,改善早产儿的营养结局,而不增加坏死性小肠结肠炎或死亡的发生风险。基于国内外相关研究,该共识制订组采用证据推荐分级的评估、制订与评价方法(Grading of Recommendations Assessment, Development and Evaluation),从早产儿肠内营养的目标、过渡期的肠内营养、稳定生长期的肠内营养、肠内特殊营养素的补充及肠内营养的监测等5个方面提出20条推荐意见,旨在为相关从业人员提供早产儿肠内营养管理的建议,以改善早产儿的临床结局。.
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  • 文章类型: Journal Article
    生活质量(QoL)评估是癌症护理不可或缺的一部分,然而,它们在提供支持幸存者的基本信息方面的有效性各不相同。本研究旨在从医疗保健专业人员的角度阐明结直肠癌幸存者QoL的关键指标,并评估与这些指标相关的现有QoL问卷。进行了两项研究:一项Delphi研究,以确定关键的QoL指标,并对适合结直肠癌幸存者的问卷进行范围审查。54名医疗保健专业人员参加了德尔福研究的第一轮,第二个是25。该研究确定了两个主要的QoL领域(生理和心理)和17个被认为最关键的子领域。此外,对12份问卷的审查显示了两种评估最重要一般领域的工具。研究结果强调了现有评估工具与医疗保健专业人员在结直肠癌幸存者工作中的临床优先事项之间的不一致。为了增强对幸存者QoL的支持,需要努力开发更符合临床实践中常规QoL评估要求的工具。
    Quality of life (QoL) assessments are integral to cancer care, yet their effectiveness in providing essential information for supporting survivors varies. This study aimed to elucidate key indicators of QoL among colorectal cancer survivors from the perspective of healthcare professionals, and to evaluate existing QoL questionnaires in relation to these indicators. Two studies were conducted: a Delphi study to identify key QoL indicators and a scoping review of questionnaires suitable for colorectal cancer survivors. Fifty-four healthcare professionals participated in the Delphi study\'s first round, with 25 in the second. The study identified two primary QoL domains (physical and psychological) and 17 subdomains deemed most critical. Additionally, a review of 12 questionnaires revealed two instruments assessing the most important general domains. The findings underscored a misalignment between existing assessment tools and healthcare professionals\' clinical priorities in working with colorectal cancer survivors. To enhance support for survivors\' QoL, efforts are needed to develop instruments that better align with the demands of routine QoL assessment in clinical practice.
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  • 文章类型: Journal Article
    精神分裂症患者(PWS)的护理通常由社区心理健康团队在门诊提供。然而,PWS经常需要住院治疗,因为广泛的临床,个人和/或社会情况。不幸的是,根据我们的知识,在PWS的出院决策过程中没有可用的指南来帮助精神科医生.该项目的目的是就PWS在急性住院精神病院后的出院标准达成专家共识。
    使用改良的Delphi方法,整个西班牙的42名精神科医生评估了有关此问题的四个感兴趣领域:临床症状学,治疗相关因素,出院后的后续保健单位,以及身体健康和监测。
    两轮后,在64份声明中,59份(92.2%)声明达成共识。在关于“临床症状学”的17项陈述中的3项(17.7%)和关于“出院后随访保健单位”的15项陈述中的2项(13.3%),没有达成共识;相比之下,所有关于“治疗相关因素”和“身体健康和监测”的陈述都达成了共识。共识结果强调了出院控制症状而不是入院时抑制症状的重要性,以及在选择抗精神病药物时的耐受性。
    尽管缺乏相关数据来指导PWS在急性住院精神病院住院后的出院,我们希望这种基于专家意见的共识可能有助于临床医生做出适当的决定.
    UNASSIGNED: The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit.
    UNASSIGNED: Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring.
    UNASSIGNED: After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on \'clinical symptomatology\' and 2 (13.3%) of the 15 statements on \'follow-up health care units after discharge\', a consensus was not reached; in contrast, a consensus was reached for all statements concerning \'treatment-related factors\' and those concerning \'physical health and monitoring\'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic.
    UNASSIGNED: Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.
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  • 文章类型: English Abstract
    拔牙是口腔颌面外科中常见且广泛使用的治疗方法。微创拔牙可以减少患者的生理和心理创伤,并被广泛推荐作为一线临床治疗。但是目前尚无指南或共识来系统地介绍微创拔牙来指导临床实践。为了解决这个问题,这一共识,基于全面的文献综述和专家的临床经验,系统地总结了适应症,目标患者,和微创拔牙的禁忌症,该程序的总体工作流程(术前准备,手术步骤,术后管理,术后指导,药物,和后续行动),及其术后常见并发症,为该技术的临床应用提供全面指导。
    Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery. Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients, and is widely recommended as a first-line clinical treatment. But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices. To address this issue, this consensus, based on a comprehensive literature review and clinical experiences of experts, systematically summarizes the indications, target patients, and contraindications of minimally invasive tooth extraction, the overall workflow of this procedure (preoperative preparation, surgical steps, postoperative management, postoperative instructions, medications, and follow-up), and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.
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