Nan-nan Shi

Adoption in China of Clinical Practice Guidelines for Hypertension Using Traditional Chinese Medical Approaches: A Literature Review Based on Clinical Studies

BACKGROUND Increasing Clinical Practice Guidelines (CPGs) of Traditional Chinese Medicine (TCM) have been developed in China, and it is not clear about the real application in the clinical studies. This study aimed to analyze the adoption of CPGs for hypertension using TCM therapy by investigating the clinical research literature on representative CPGs for TCM in China. METHODS All CPGs on TCM for hypertension were collected and investigated from all of the clinical research literature published in China from January 2005 to December 2010. Ten (10) CPGs on TCM for hypertension were searched and analyzed, collecting data about the issuing organization, date of publication, classification, characteristics, contents, and citation rates. RESULTS By the end of December 2008, 10 CPGs on TCM for hypertension were found. Of these guidelines, one was a Chinese national standard, one was a local authority standard, two were professional administration standard, and six were academic association standards. Furthermore, four were compiled under the title of hypertension based on TCM syndrome differentiation and six were only compiled under the title of a TCM syndrome. Of all the research articles (n=695), TCM CPGs were cited in 417 articles (60%). TCM CPGs on hypertension were commonly used as standards for diagnosis and/or outcome measurements. Three hundred and seventy-nine (379) clinical research articles were unclear or inconsistent in their adoption of TCM CPG, accounting for 55% of all clinical articles. Seven (7) categories of inconsistent or unclear citations of TCM CPG were identified, and the total amount of occurrences of seven categories on inconsistent citation was 572. CONCLUSIONS About 60% publications cited the CPGs for their clinical research, and most of them cited in an inconsistent and unclear way. According to the result, better training of TCM practitioners and improvement of CPG development and adoption are needed.

Development of Clinical Practice Guidelines in 11 Common Diseases with Chinese Medicine Interventions in China

ObjectiveTo analyze the clinical practice guideline (CPG) development on 11 common diseases with Chinese medicine (CM) interventions in China. MethodsThe CPGs of 11 common diseases which could be treated effectively with CM had been published between 1980 and 2010 in China. The 11 diseases include coronary heart disease (angina pectoris), hypertension, chronic gastritis, rheumatoid arthritis, cerebral infarction, migraine, diabetes, primary osteoporosis, insomnia, common cold, and IgA nephropathy. The issuing organization, date of publication, development methods, and citation rate of the CPGs were analyzed. According to the development method, each guideline was categorized as consensus-based (CB), evidence-based (EB), or consensus based with no explicit consideration of evidence-based (CB-EB). ResultsThirty-three CPGs on the 11 common diseases were found: 20 guidelines were classified as CB, 13 as CB-EB and none as EB. Fifteen CPGs were issued by the China Association of Chinese Medicine, 8 by professional working groups, and 4 by the State Administration of Traditional Chinese Medicine. Six guidelines were published between 1980 and 1990, 9 between 1991 and 2000, and 18 between 2001 and 2010. Fifty-eight percent of these guidelines have not been amended timely. Only 54.5% (18/33) of the 33 guidelines were cited by other researchers and 45.5% (15/33) percent had never been cited. ConclusionsMost CPGs developed for 11 common diseases with CM approaches in China are consensus, and their citation rates are relatively low. The results suggest that more EB CPG or CPG strictly based on expert consensus could be developed, and great efforts should be made for future CM CPG application.

Current situation of International Organization for Standardization/Technical Committee 249 international standards of traditional Chinese medicine

ObjectiveTo review the current situation and progress of traditional Chinese medicine (TCM) international standards, standard projects and proposals in International Organization for Standardization (ISO)/ technical committee (TC) 249.MethodsISO/TC 249 standards and standard projects on the ISO website were searched and new standard proposals information were collected from ISO/TC 249 National Mirror Committee in China. Then all the available data were summarized in 5 closely related items, including proposed time, proposed country, assigned working group (WG), current stage and classifification.ResultsIn ISO/TC 249, there were 2 international standards, 18 standard projects and 24 new standard proposals proposed in 2014. These 44 standard subjects increased year by year since 2011. Twenty-nine of them were proposed by China, 15 were assigned to WG 4, 36 were in preliminary and preparatory stage and 8 were categorized into 4 fifields, 7 groups and sub-groups based on International Classifification Standards.ConclusionA rapid and steady development of international standardization in TCM can be observed in ISO/TC 249.

Enhanced Evidence-Based Chinese Medicine Clinical Practice Guidelines in Hong Kong: A Study Protocol for Three Common Diseases

We presented a study protocol of developing Chinese medicine clinical practice guidelines for three common diseases in Hong Kong, including insomnia, chronic gastritis, and cerebral infarction. This research project will be conducted in three phases. First phase is the preparation stage which consists of the establishment of steering committee and panel. Second phase involves 6 steps, which are searching and identifying evidence, text mining process, Delphi survey, synthesizing of data, consensus conference, and drafting guidelines. In this phase, text mining technique, evidence-based method, and formal consensus method are combined to get consolidated supporting data as the source of CM CPGs. The final phase comprised external reviews, dissemination, and updating. The outputs from this project will provide three CM CPGs for insomnia, chronic gastritis, and cerebral infarction for Hong Kong local use.

Evidence-based chinese medicine clinical practice guideline for stomach pain in Hong Kong

Stomach pain in Chinese medicine (CM) is a very common disorder in clinical practice and it has been listed as one of the pilot three conditions in Hong Kong to develop evidence-based CM clinical practice guidelines (CM CPGs). The aim of this stomach Pain CPG is to summarize the treatment methods of stomach pain with CM and evaluate reasonably, then to guide local licensed CM practitioners and provide beneficial reference for social medical decision makers and patients. In this manuscript, we defined stomach pain in CM and the category of chronic gastritis in Western medicine. The clinical manifestation, CM pattern classification, and CM intervention including herbal medicine treatment based on pattern differentiation, symptomatic treatment, acupuncture treatment, regulation and nursing were illustrated.

Developing clinical practice guidelines for the integration of Chinese medicine and biomedicine: A new process

Abstract Introduction Despite the integration of Chinese medicine and biomedicine which has emerged in clinical practice worldwide, a comprehensive development process for clinical practice guidelines (CPG) has up to now been missing. A valid method for the rational use of predictions for herb-drug interaction is a biggest challenge in guideline development process. Methods This article summarises the development process by reviewing key literature from CPG developers. It focuseson key methods and challenges specific to CPGs for integration by using text mining and bioinformatics to provide a powerful adjunct to CPG development. Results The guideline development process identified, together with new approaches, incorporates evidence-based methodology and provides better decisions through analysis of uncertain herb-drug interaction. Conclusions This new process used three basic phases (preparation, development, and finalization) and seven steps providing a set of methodological principles for CPG development intergrating Chinese medicine and biomedicine.