The effective implementation of clinical practice guideline(CPG), as a crucial vehicle of evidence-based medicine, plays a vital role in improving healthcare quality and patient safety. Currently, there remains a significant gap between the actual implementation outcomes of traditional Chinese medicine(TCM) guidelines and their intended objectives, which necessitates a systematic investigation into their influencing factors to optimize implementation strategies. This study aims to comprehensively identify the factors influencing CPG implementation in China, adapt the theoretical domains framework(TDF) to the local context, and integrate TCM-specific characteristics to provide recommendations for optimizing the development and implementation processes of TCM guidelines. Systematic search was conducted across multiple databases, including CNKI, Wanfang, VIP, SinoMed, PubMed, and EMbase, covering the period from each database's inception to March 2024. Qualitative and mixed-methods studies were included to examine factors affecting the implementation of clinical practice guidelines. The methodological quality of the included studies was assessed using the critical appraisal skills programme(CASP) tool. RESULTS:: were synthesized through framework analysis and thematic synthesis, and expert consensus was achieved via a structured consensus meeting. A total of 16 studies involving 2 388 participants were included with overall good methodological quality. Based on the TDF, 43 influencing factors across 14 domains were identified. The most critical factors included the quality of guideline evidence, training and academic conferences organized by hospitals and academic institutions to promote guideline adoption among medical staff, support from professional leaders for guideline implementation, the applicability and clarity of guideline recommendations, and material resources(supplies, funding, and facilities) required for implementation. Additionally, influencing factors of TCM guideline implementation were identified, including the distinctive advantages of TCM therapies, the applicability of syndrome differentiation, and the feasibility of TCM treatments. Based on these findings, it is recommended that TCM guideline development should incorporate these unique influencing factors to formulate high-quality, clear, and actionable recommendations. Following guideline publication, healthcare and academic institutions should strengthen training and dissemination efforts and ensure the availability of necessary implementation resources to facilitate the successful adoption of guidelines in clinical practice.
China ; Humans ; Practice Guidelines as Topic ; Medicine, Chinese Traditional/standards* ; Evidence-Based Medicine

To enhance medication safety and rational use, a multidisciplinary expert panel from the Yangtze River Delta region-comprising specialists in pharmacy, clinical medicine, healthcare administration, and evidence-based medicine-was convened to develop this consensus through multiple rounds of Delphi consultation. A management system for the off-label use of novel antineoplastic agents was established, incorporating a tiered management process and a regional information sharing platform. Standardized procedures were implemented to regulate the applications, review, documentation, and dynamic adjustment of off-label use. The regional platform centralizes the collection and evaluation of evidence for off-label usage, facilitating consistent and homogeneous manage-ment across healthcare institutions. The tiered management process and information sharing platform established herein are intended to serve as a practical reference for standardizing the management of off-label use of novel antineoplastic agents in medical institutions.
Antineoplastic Agents/therapeutic use* ; Humans ; Off-Label Use/standards* ; Consensus ; Evidence-Based Medicine

The expert consensus on clinical practice of Chinese patent medicines shall be regarded as the same with clinical practice guidelines,which shall be concise,readable and applicable. Therefore,a formal expert consensus is unable to contain the whole compilation process and the content of its important process documents. It is necessary to write instructions for continuation,expansion and publicity. In 2018 Standardization Department of China Association of Chinese Medicine invited methodologists with the background of evidence-based medicine drafted a series of standards for expert consensus on clinical practice of Chinese patent medicines,including the guidance for compilation the instructions. It will be useful for readers of expert consensus to understand the work behind the compilation,so as to make the compilation process more transparent and standardized. We proposed nine requirements for compilation the instructions,namely content and requirements,work overview,main technical content,compilation process,process and basis for handling major disagreements,expert consensus implementation requirements and measure suggestions,other issues need to be explained,appendix and format for instructions.
China ; Consensus ; Evidence-Based Medicine ; Medicine, Chinese Traditional ; standards ; Nonprescription Drugs ; standards

In 2018,Standardization Department of China Association of Chinese Medicine invited methodologists with the background of evidence-based medicine to discuss and draft a series of standards for expert consensus on clinical practice of Chinese patent medicines. These standards have been made by reference to the published standards for developing expert consensus and clinical practice guidelines. These standards were made based on full consideration of the current evidence status and the history of clinical practice of Chinese patent medicines. These standards were composed of four parts,namely information summary items,normative general items,normative technical items and information supplementary items,including cover,content,preface,introduction,title,scope,basic Information of Chinese patent medicine,suggestions for clinical application,safety,conflict of interest,appendix,and references,so as to provides reference for improving the quality of expert consensus-based compilation and enhancing the applicability of expert consensus.
China ; Consensus ; Evidence-Based Medicine ; Humans ; Medicine, Chinese Traditional ; standards ; Nonprescription Drugs ; standards

This paper summarizes the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions revised by the Agency for Healthcare Research and Quality (AHRQ) and introduces how to use Revman software make risk of bias graph or risk of bias summary. AHRQ tool can be used to evaluate following study designs: RCTs, cohort study, case-control study (including nested case-control), case series study and cross-sectional study. The tool evaluates the risk of bias of individual studies from selection bias, performance bias, attrition bias, detection bias and reporting bias. Each of the bias domains contains different items, and each item is available for the assessment of one or more study designs. It is worth noting that the appropriate items should be selected for evaluation different study designs instead of using all items to directly assess the risk of bias. AHRQ tool can be used to evaluate risk of bias individual studies when systematic reviews of health care interventions is including different study designs. Moreover, the tool items are relatively easy to understand and the assessment process is not complicated. AHRQ recommends the use of high, medium and low risk classification methods to assess the overall risk of bias of individual studies. However, AHRQ gives no recommendations on how to determine the overall bias grade. It is expected that future research will give corresponding recommendations.
Bias ; Evidence-Based Medicine/standards* ; Health Services Research ; Systematic Reviews as Topic

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Chronic Obstructive Pulmonary Disease (COPD) to provide doctors and patients in Singapore with evidence-based treatment for COPD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on COPD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: https://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Adult ; Aged ; Evidence-Based Medicine ; Humans ; Middle Aged ; Palliative Care ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; therapy ; Pulmonary Medicine ; standards ; Quality Improvement ; Radiography, Thoracic ; Risk Factors ; Singapore ; Steroids ; therapeutic use

There are vast land and lots of people in western China, but the economy developing is relatively slow. However, the minimally invasive surgery was carried out firstly in China. Moreover, the type, number and difficulty of the minimally invasive surgery increased year by year. Especially, in the western area of China, Dr Zhou Zongguang, Yu Peiwu and Zheng Shuguo et al. have performed much pioneering work in laparoscopic surgery for rectal cancer, gastric cancer and laparoscopic liver resection. They led the standard development of minimally invasive in China. In the future, western China should continue to strengthen the standardized training of minimally invasive surgery, make great effort to carry out evidence-based research of minimally invasive surgery, provide evidences of high level of clinical application in minimally invasive surgery. At the same time, we should carry out the robotic and 3D laparoscopic surgery actively, leading the development of minimally invasive surgery more standardized and more widespread in western China.
China ; Digestive System Surgical Procedures ; methods ; trends ; Evidence-Based Medicine ; Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Minimally Invasive Surgical Procedures ; education ; methods ; standards ; trends ; Rectal Neoplasms ; surgery ; Robotic Surgical Procedures ; Stomach Neoplasms ; surgery

Colorectal cancer is a systemic disease that requires multidisciplinary treatment. The comprehensive quality of colorectal surgeon directly impacts on the efficacy of diagnosis and treatment of colorectal cancer. Multidisciplinary teams help surgeons enhance their ability of evidence-based medicine, improve the quality of main specialty, expand the knowledge of other specialty, enhance the doctor-patient communication, and increase the research level. Thus, multidisciplinary teams can improve the comprehensive quality of colorectal surgeons.
Colorectal Neoplasms ; diagnosis ; therapy ; Colorectal Surgery ; Communication ; Evidence-Based Medicine ; methods ; Humans ; Interdisciplinary Communication ; Patient Care Team ; standards ; Physician-Patient Relations ; Quality of Health Care ; Surgeons ; standards

The development and compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma are introduced from three aspects, named the guideline methodology, the guideline structure and the guideline content. Based on the acupuncture-moxibustion practice and clinical research, the evidence-based medicine method is adopted. During the development and compilation of the guideline, the characteristics and advantages of acupuncture and moxibustion are specially considered in the treatment of this disease; the latest optimum evidences at home and abroad, experts' experience and patients' value are closely integrated with each other. Additionally, the worldwide accepted assessments of evidence quality and the recommendation (GRADE system) are combined with the clinical evidences of the ancient and modern famous acupuncture-moxibustion experts, and the clinical research evidences are with the experts' consensus to the large extent. The purpose of the guideline is to provide the maximal guidance to the clinical physicians.
Asthma ; therapy ; Evidence-Based Medicine ; standards ; Humans ; Moxibustion ; standards ; Practice Guidelines as Topic ; Reference Books

Evidence-based medicine (EBM) has been widely applied in clinical study of acupuncture and moxibustion, and the real-world study (RWS) has gradually become an important way of clinical research in the world in recent years. It is worthy of our in-depth study and discussion that how to evaluate the advantages and limitations of EBM and RWS as well as their reasonable application in clinical study of acupuncture and moxibustion. The characteristics and difference between RWS and EBM, and the situation of acupuncture clinical research methods are discussed in this paper. It is proposed that we should understand the advantages of RWS in acupuncture clinical research, fully realize the limitations of EBM and RWS, recognize the complexity and particularity of RWS, and apply EBM and RWS into acupuncture clinical research. Meanwhile acupuncture clinical manipulation standardization should be further promoted, which is benefit to develop clinical study, improve clinical efficacy and promote the popularization of acupuncture and moxibustion.
Acupuncture Therapy ; standards ; Biomedical Research ; standards ; Evidence-Based Medicine ; standards ; Humans ; Medicine, Chinese Traditional ; Moxibustion ; standards