Search

Evidence is a core element of evidence-based medicine, with diverse classifications and extensive sources. Most of it is based on journals and is commonly found in databases or websites such as PubMed, Web of Science, and CNKI. The number of literatures is countless, which also puts enormous pressure on researchers to consult and read literature. The field of urology is no exception. This article started with analyzing the characteristics of common clinical questions in the field, introduced the four criteria for their screening and two types of structured templates, clarified the definition, categories, identification, and three requirements for the application of the four evidence classification methods, and explained the selection of retrieval resources, construction of retrieval strategies, specific operational steps, and precautions for the retrieval process to develop and use evidence. In addition, combined with artificial intelligence technology, the future development trend of evidence classification and retrieval in the field of evidence-based urology has been clarified, which provided reference for further promoting the development of evidence-based urology.

In recent years, the number of clinical practice guidelines for the integration of traditional Chinese medicine (TCM) and western medicine(WM) has been increasing year by year. However, there are obvious problems of "knot without compatibility". The recommendations of TCM and WM are mostly independent, inconsistent with the actual clinical diagnoses and treatment processes, and lacking in important information. All the above issues are unable to bring the role of the cooperation between TCM and WM in improving clinical practice. In order to achieve the organic integration of Chinese and western medicine, the research team has carried out methodological research in response to the above-mentioned problems. In November 2023, China Association for Standardization released the Specifications for Developing Clinical Practice Guidelines for Organic Integration of Traditional Chinese and Western Medicine at the 6th-8th Academic Annual Meeting of the Clinical Research Branch of China Information Association of Traditional Chinese Medicine. Therefore, this paper interprets the formulation process, scope of application and main content of the specification, with the aim of improving the overall quality of related research and promoting the collaborative development of the integration of TCM and WM.

Objective To explore the construction of a real-world data annotation platform, and compare the real-world data extraction performance of retrieval augmented generation (RAG) combined with large language models and pre-training fine-tuning methods for pre-trained language models.Methods Taking the pathological records of bladder cancer in the real world electronic medical record data as an example, a real-world data annotation platform was built. Based on the platform annotation data, the effects of automatic extraction of cancer typing and staging of bladder cancer using RAG combined with GPT-3.5, and the pre- training fine tuning method based on BERT and RoBERTa models were compared. Results The extraction effects of the pre-training and fine-tuning model based on the fine-tuning of the full-training set were better than that of RAG combined with large model method and pre-training and fine-tuning model with the few-shot fine-tuning, and the effects of RoBERTa model were generally better than that of BERT model, but the extraction effects of these methods needs to be improved totally. The F1 scores for extracting bladder cancer typing, T staging, and N staging in the test set, using the RoBERTa model fine-tuned with the entire training set, were 71.06%, 50.18%, and 73.65% respectively. Conclusion Pre-trained language models have the application potential in processing clinical unstructured data, but there is still room for improvement in the information extraction effect of existing methods. Future work requires further optimization of models or training strategies to accelerate data empowerment.

China is actively promoting Diagnosis-Related Group (DRG)/Diagnosis-Intervention Packet (DIP) payment reform alongside the implementation of clinical pathways. While existing research has explored the impact of DRG/DIP reform on healthcare service behaviors and public health, there is limited investigation into the synergistic mechanisms between clinical pathways and healthcare payment reform. China currently faces challenges in implementing both DRG/DIP payment reform and clinical pathways. However, given that both aim to control medical costs and improve the quality of care, they possess a high degree of compatibility. This paper examined the content of healthcare payment reform and delve into how clinical pathways and payment reform can achieve synergistic effects. It further explored how clinical pathways and DRG/DIP can be deeply integrated to maximize their combined impact, providing valuable insights for the application and promotion of DRG/DIP payment and clinical pathways.

Objective To systematically analyze relevant literature on evidence-based urology (EBU) in China and abroad, and to understand their definitions and methodological research status. Methods The PubMed, Web of Science, CNKI, Wanfang, VIP Database for Chinese Technical Periodicals, and SinoMed were searched, JD.com and Dangdang.com engines are used to assist retrieval. The search was conducted as of August 9, 2023. The connotation and methodological research characteristics of EBU were extracted, and then used content analysis to integrate the extracted information. Results A total of 37 literature were included. There was no literature on the definition of EBU yet, and the research topics involved randomized controlled trials, systematic review, guidelines, evidence grading, Cochrane Library and PubMed database literature retrieval, evidence-based clinical decision-making, etc. 12 articles focused on 11 topics of randomized controlled trials or clinical trials such as subgroup analysis, relative and absolute effects, alternative endpoints; 5 articles introduced 4 themes of systematic review including heterogeneity, publication bias, P-value and confidence interval, and likelihood ratio; 9 literature systematically outlined the key methods of evidence-based medicine and provide evidence support for clinical questions related to the urinary system diseases. In terms of writing format, cases of urinary system diseases were used for explanation. Conclusion The definition of EBU has not yet been clarified, but it has a good foundation of development and constructionn, and the theoretical system EBU needs to be further improved. For example, starting with the complexity of the problems emerging in urology, actively proposing new ways of solving them, enriching research evidence types, innovating grading standards, expanding the clinical decision-making methods of EBU, and accelerating the optimization of subject curriculum system and talent cultivation.

Clinical pathway informatization is the inevitable trend of clinical pathway development. Based on the hospital management information system, it can realize the clinical pathway information management and build the knowledge base of clinical path decision-making and treatment. It can further support the adaptive dynamic adjustment of clinical pathway. Informatization of clinical pathway is the core of clinical pathway information management. This article elaborates the construction basis of clinical pathway information management and the construction of clinical pathway knowledge base, so as to provide reference for the development and management of clinical pathway from the perspective of information management.

With the development of medical big data, the real-world study (RWS) has received increasing attention in recent years, and has a good promising prospect. However, there are still some challenges in the implementation of RWS that has led to extensive discussion among scholars. The most urgent issue currently to be addressed is the unstructured nature of real-world data (RWD). Based on regular expressions, this study used rule-based information extraction method to extract structured information from admission records, pathological reports, surgical records, and image records of bladder cancer patients in Zhongnan Hospital of Wuhan University in recent years, and evaluated the extraction effects with accuracy and recall as indicators, aiming to provide reference for subsequent research.

With the development of the Scientific, Transparent and Applicable Rankings tool for clinical practice guidelines(STAR), the publication of evaluation and ranking for scientificity, transparency and applicability of Chinese guidelines and consensus published in the medical journals in 2021and 2022, as well as the publication of the STAR evaluation and ranking for some specialities, the STAR evaluation and ranking has received widespread attention in the medical community. In order to further enhance its scientificity and transparency, Methodology and Technology Specialization Committee of the STAR Working Group presents this article to introduce sample identification and speciality assignment in the evaluation and ranking process.

The formulation and application of clinical pathways is a process of dynamic improvement and development. The principles of clinical pathways formulation come from multiple disciplines and are constantly enriched and polished in the clinical application of pathways. However, the methodological procedures and reporting standards for the clinical pathway formulation have not been unified internationally. In this paper, we systematically searched and screened the literature on the formulation of clinical pathways, finally determined the methodological literature on the whole process of clinical pathway formulation and comb through the development process in the 5 complete reports. Meanwhile, based on the analysis of the rest of the literature, the suggestions for the clinical pathway formulation process were put forward and discussed to provide reference for hospital managers to develop clinical pathways.

Objective To analyze the characteristics of the terminology of clinical practice guidelines and learn the expression of terminology of guidelines, to provide some reference for the research and construction of the guidelines ontology.Methods UMLS, SNOMED-CT, MeSH, OBI, schema.org, CMeSH, TCM clinical terminology, and TCMLS were systematically searched to identify and extract the terms of the guidelines and analyze the classification structure and mapping relationship of the terms of the guidelines in the ontology.Results The terms "guideline", "level of evidence" and "recommendation" were retrieved, and the hierarchical relationship, conceptual representation, and mapping relationship between the terms were analyzed.Conclusion The relevant terms of the guidelines still need to be further improved. Standardized terminology of the guidelines can eliminate the uncertainty of concepts, facilitate the development of the guidelines, and promote the sharing and utilization of guidelines' evidence and recommendations among different countries and regions.

Clinical practice guidelines are an important basis for clinical decision-making, but there are still many factors that prevent physicians from following the guidelines. One of the problems, the limited external validity of the guidelines, ultimately prevents the guidelines from providing an adequate basis for clinical decision-making, thus forming the gap between the guidelines and clinical decisions. Real-world research can enhance the external validity of the guidelines, provide a basis for clinical decision-making, and offer localized evidence for the guidelines, evidence of cost-effectiveness and other evidence for the guidelines. It can also monitor the implementation of the guidelines and help to make up for the lack of evidence in the formulation of traditional guidelines. Therefore, high-quality real-world studies and real-world evidence may be considered in the guideline development process to facilitate guideline optimization and serve as an aid to guideline quality improvement.

The significance of the existence of clinical practice guidelines lies in their implementation, however, there are still many problems in the implementation of guidelines and bottlenecks in the translation of clinical evidence. The introduction of knowledge graph technology provides a solid foundation for guideline intel-ligence and a good tool for solving guideline implementation problems. The combined Traditional Chinese Medi-cine (TCM)/ Integrated Traditional Chinese and Western Medicine (IM) reflect the characteristics of the healthcare system in China. Using the current status of TCM/IM diagnosis and treatment of cardiovascular diseases and the current problems in the application of TCM/IM guidelines for cardiovascular diseases, this study defined the objectives of constructing a knowledge graph for TCM/IM clinical guidelines for cardiovascular diseases, and accordingly designed a knowledge graph framework for TCM/IM clinical guidelines that is con-sistent with professional knowledge and practical application. We analyzed the scope of the guidelines, ar-ranged their content and summarized their knowledge structure. We then established concept structure tables and entity semantic relationship tables. The design of the knowledge graph framework for TCM/IM guidelines proposed in this paper provides a basis for the digitization and communication of guidelines, and is conducive to promoting their implementation and dissemination.

Background: Medical decision-making is a complex multi-stage process. Chinese cancer patients' preference for participation in decision-making stages, family involvement and influencing factors remain unclear. Methods: A total of 1,422 cancer patients from four tertiary hospitals in China were included in the cross-sectional survey. Patient Expectation for Participation in Medical Decision-making Scale was used to measure patients' information, deliberation and decisional control preferences. The patient-family Control Preferences Scale was used to measure expected and actual levels of family involvement. Generalized estimation equation was performed to explore factors associated with patients' preferences. Results: 93.0% of patients had a high preference for information exchange, 95.8% for treatment deliberation, and 61.7% for decisional control. Equal participation was most common in family involvement in decision-making, followed by family-led and patient-led. 15.5% of patients reported a discrepancy between expected and actual family involvement. Age, education, marital status, number of adult children, occupation, family income, regular residence, health insurance and time since diagnosis were related to patient preference. Compared to patients with other cancer sites, those with breast [odds ratio (OR) 2.02, 95%CI: 1.47–2.77] and thyroid cancer [OR 2.37, 95%CI: 1.82–3.10] had higher information preference, those with breast [OR 2.98, 95%CI: 2.73–3.26] and esophagus cancer [OR 2.86, 95%CI: 1.13–7.22] had higher deliberation preference, and thyroid cancer patients [OR 1.50, 95%CI: 1.07–2.10] had higher decisional control preference. Patients who expected or experienced equal participation had higher preference at all stages of decision-making than those with family-led involvement. Patients with inconsistent expected and actual family involvement had lower preferences for the deliberation [OR 0.53, 95%CI: 0.36–0.77] and decisional control stages [OR 0.67, 95%CI: 0.56–0.79]. Conclusions: Chinese cancer patients generally have high preference for information exchange and treatment deliberation, but varied preferences for decision control, influenced by patients' sociodemographic factors, cancer types, time since diagnosis and family involvement. The findings underscore the importance of tailoring medical decision-making processes to individual patient preferences and ensuring family involvement aligns with patient expectations to enhance patient-centered care in China. [ABSTRACT FROM AUTHOR]

Concrete box subgrades constructed from reinforced concrete serve as alternatives to conventional fill subgrades, effectively addressing the scarcity of high-quality fill materials. A hybrid simulation approach that merges coupled dynamics with finite element modelling was adopted for both single-line and double-line ballastless track-box subgrade systems, enabling a comparative analysis of dynamic stress, displacement, and acceleration. The results reveal that, when the two traffic conditions are compared, the dynamic response of the concrete box subgrade under double-line opposing operation shows a marked increase, particularly when the dynamic displacement increases by 80%. Under opposing traffic conditions, the dynamic stress on the subgrade surface exhibits a "saddle" distribution. Vertically, the dynamic stress inversely increases within the roof and rapidly attenuates in the vertical web and floor, with reductions reaching 92.7% at the floor bottom, demonstrating the substantial capacity of the concrete box subgrade to disperse train loads. The peak dynamic displacements recorded at the subgrade surface are 0.178 mm for single-line traffic and 0.320 mm for opposing operations, indicating minimal overall vertical deformation of the concrete box subgrade. Notably, the dynamic displacement on the subgrade surface results primarily from the underlying weak subsoil. Vertical acceleration attenuation occurs predominantly within the vertical web depth, with attenuation rates exceeding 95%. The environmental vibrations induced by high-speed trains predominantly affect the area within 0 to 4 m from the edge of the subgrade floor. [ABSTRACT FROM AUTHOR]

Objective: Clinical practice guidelines (CPGs) for Integrated Traditional Chinese and Western Medicine (TCM and WM) are important medical documents used to assist medical decision‐making and are of great significance for standardizing clinical pathways. However, due to the constraints of text format, it is difficult for Integrated TCM and WM CPGs to play a real role in medical practice. In addition, how to standardize the structure and semantic relationships between Integrated TCM and WM CPG knowledge, and realize the construction of computable, sharable and reliable CPGs, remains an urgent issue to be addressed. Therefore, we are proposing an ontology of CPGs for Integrated TCM and WM. Methods: We first initialized domain concepts and relationships to ensure the accuracy of the ontology knowledge structure. We then screened CPGs that meet the standards for Integrated TCM and WM, analyzed and classified the contents, and extracted the common structures. Based on the seven‐step ontology construction method combined with inference‐complement, referring to the representation methods and hierarchical relationships of terms and concepts in MeSH, ICD‐10, SNOMED‐CT, and other ontologies and terminology sets, we formed the concept structure and semantic relationship tables for the ontology. We also achieved the matching and mapping between the ontology and reference ontologies and term sets. Next, we defined the aspects and constraints of properties, selected multiple Integrated TCM and WM CPGs as instances to populate, and used ontology reasoning tools and formulated defined inference rules to reason and extend the ontology. Finally, we evaluated the performance of the ontology. Results: The content of the Integrated TCM and WM CPGs is divided into nine parts: basic information, background, development method, clinical question, recommendation, evidence, conclusion, result, and reason for recommendations. The Integrated TCM and WM CPG ontology has 152 classes and defines 90 object properties and 114 data properties, with a maximum classification depth of 4 layers. The terms of disease, drug and examination item names in the ontology have been standardized. Conclusions: This study proposes an Integrated TCM and WM CPG ontology. The ontology adopts a modular design, which has both sharing and scaling ability, and can express rich guideline knowledge. It provides important support for the semantic processing and computational application of guideline documents. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations. Background: Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial. Methods: Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators. Results: Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema. Conclusion: In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details. Summary statement: What is already known about this topic? Providing recommendations based on evidence‐based guidelines for care of cancer treatment‐related lymphoedema will help to improve outcomes for patients with this chronic condition. What this paper adds? The rigour of the guidelines needs to be improved.Guideline‐making organizations have the responsibility to promote the application of guidelines into practice using a variety of methods.Multifactorial reasons were responsible for the differences inguidelines' recommendations The implications of this paper Nurses need to be more aware of guideline recommendations.There are inconsistencies in the details, despite many similarities.The formulation of individual nursing care programmes should be tailored to the local clinical situation and working environment. [ABSTRACT FROM AUTHOR]