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Clinical practice guidelines can facilitate the standardization of the diagnosis and treatment and improve health care quality. However, there are barriers to guideline dissemination and implementation, thus impeding the standardization of clinical practice and improvement of patient outcomes. One major barrier is that it is difficult for doctors to read and understand the unstructured text-based guidelines, and apply them in real clinical practice. This paper introduces the design of decision trees based on clinical practice guidelines, and the advantages, challenges and solutions of this approach, with the hope of providing references for promoting the transformation of textual clinical practice guidelines.

Objective To analyze the status of dissemination and implementation of Chinese clinical practice guidelines published in medical journals in 2019, and to propose suggestions on promoting the dissemination and implementation of Chinese guidelines in the future. Methods We analyzed Chinese guidelines published in 2019 on the following aspects: reporting the dissemination and implementation; being published in multiple journals, editions and languages. Besides, we also searched published interpretation reports related to 2019 Chinese guidelines so as to understand the status of dissemination and implementation of guidelines in China. Results A total of 226 Chinese guidelines published in medical journals in 2019 were identified. Only 5.8% (13/226) reported the information on dissemination and implementation with 12 different strategies. Dissemination and implementation by academic conferences and social media were mostly mentioned and reported in 8 guidelines. As for the application of the strategies of dissemination and implementation, 12.4% (28/226) published in different journals; 9.3% (21/226) published different editions; 8.4% (19/226) published both English and Chinese versions. After search and screening, we included 48 interpretation reports, which interpreted 30 (13.3%, 30/226) Chinese guidelines. The median interval of publication time between the guideline and interpretation study was 5.5 months. Conclusions The reporting rate of dissemination and implementation and the application of related strategies of Chinese guidelines published in 2019 were relatively low. We suggest that guideline developers should develop specific and detailed strategies on guideline dissemination and implementation, and follow the reporting guidance.

Objective To investigate the reporting of research gaps in Chinese clinical practice guidelines published in medical journals in 2019 and to make targeted suggestions for standardising and clearly reporting research gaps. Methods We systematically reviewed Chinese clinical practice guidelines published in medical journals in 2019, extracted and analyzed information relevant to research gaps. Results Of the 226 guidelines published in 2019, 27 guidelines (11.9%) reported a total of 78 research gaps, and the median number of reports was 2(range: 1 to 10). Of these guidelines, 11 guidelines presented research gaps in separate sections such as 'problems to be solved' 'priority suggestions for future research 'or' suggestions for future research ', while 16 guidelines integrated research gaps into other sections, such as' summary' 'discussion' or 'epilogue'. In terms of content, the main focuses are on efficacy (15.4%, 12/78), safety (12.8%, 10/78), new methods/solutions/technologies/products (10.3%, 8/78) and biomarkers (9.0%, 7/78). In terms of clarity, only 45 research gaps (57.7%, 45/78) were deconstructed to include 2 or more of these elements according to the PICO (P, population; I, intervention; C, comparison; O, outcomes) principles. Conclusions The reporting rate and the clarity of research gaps in the 2019 Chinese guidelines need to be improved, and the location of research gaps is not fixed. It is recommended that guideline developers independently report on research gaps in the guideline and aim to make it standard, comprehensive and clear, so as to provide direction for future researches.

Objective To evaluate the methodological and reporting quality of Chinese clinical practice guidelines published in medical journals in 2019, so as to understand their current quality and provide suggestions for the improvement of guideline development. Methods We used the AGREE Ⅱ tool and the RIGHT checkilist to assess the methodological and reporting quality of Chinese clinical practice guidelines respectively. The average score or average reporting rate was calculated for each domain and the overall. We used 60% as the qualified threshold. Results A total of 226 guidelines meeting the criteria were included. The average score of AGREE Ⅱ was 22.3%, and the scores of six domains were as follows: 37.9% (scope and purpose), 23.2% (stakeholder involvement), 14.9% (rigour of development), 39.1% (clarity of presentation), 14.6% (applicability), and 22.5%(editorial independence). The average reporting rate of RIGHT was 33.9%, and the reporting rates of seven domains were as follows: 59.2% (basic information), 51.9% (background), 10.8% (evidence), 31.5% (recommendation), 4.4% (review and quality assurance), 22.3%(funding and declaration and management of interests), and 14.5% (other information). Compared to unregistered guidelines, 12 registered guidelines had a 24.3% higher mean score (48.3% vs. 24.0%) in AGREE Ⅱ and a 21.2% higher mean reporting rate (54.0% vs. 32.8%) in RIGHT. Conclusions The overall methodological and reporting quality of Chinese clinical practice guidelines published in medical journals in 2019 were relatively low. Registered guidelines had higher overall scores than unregistered guidelines.

Objective To investigate the methodological issues related to the quality of evidence and strength of recommendations of 2019 Chinese clinical practice guidelines (hereafter referred to as 'guidelines') published in journals, so as to provide reference for standardization of recommendations. Methods We searched and analyzed information on Chinese guidelines published in 2019, evaluated the quality of evidence, and graded the strength of recommendations. Information on grading methods, grading descriptions, phrases for the quality of evidence, and the strength of recommendation was extracted. Results A total of 226 Chinese clinical practice guidelines were published in journals in 2019, of which 106 guidelines (87 Chinese guidelines, 19 English guidelines) were included in this study. There were 18 grading methods adopted, with the GRADE(Grading of Recommendations Assessment, Development and Evaluation) system being the most used(35.8%, 38/106). A total of 6 grading descriptions were used; the most frequently used symbol for grading the quality of evidence was letters (39.6%, 42/106); the most frequently used symbol for grading the strength of recommendations was text (34.9%, 37/106). The most common word used in the guidelines to describe the recommended strength was 'may'. Among the 38 guidelines that used the GRADE system, only 15 followed the presentation recommended by the GRADE working group. There were 250 clearly graded recommendations included, with 60.4% (151/250) being strong recommendations and 44.8% (112/250) citing low or very low-quality evidence. There were 96 recommendations(38.4%, 96/250) that were supported by systematic reviews. Conclusions Chinese guidelines published in journals in 2019 that used the grading system accounts for a small proportion compared with those that did not use. And the quality of evidence and strength of recommendations used in guidelines remains incomplete, inconsistent and irregular. The GRADE system is underused. Very few guidelines present grading criteria and details in accordance with the requirements of the GRADE Working Group.We recommend the use of the GRADE system to promote the rigorous, transparent and rational development of guideline recommendations.

Objective To investigate the current status of evidence of recommendations contained in Chinese clinical practice guidelines published in journals in 2019, so as to provide reference for the use of evidence for Chinese guidelines in the future. Methods We searched and analyzed information on Chinese guidelines published in 2019 with clear recommendations, grading of evidence quality and corresponding instructions of grading, as well as information on citations supporting the recommendations. Results A total of 31 guidelines (29 Chinese guidelines and 2 English guidelines) containing 568 recommendations and 3126 references were included. Each guideline included an average of 18 recommendations. Of these, 2541 references were presented as evidence in the statements of guideline recommendation(such references are referred to as 'evidence' hereafter). The average number of evidence was 82 in each guideline and every recommendation has 4 pieces of evidence. The top three countries where the evidence was from were China (28.8%), the United States (25.9%), and the United Kingdom (7.0%). Only 39.2% (995/2541) of the evidence was published in the last 5 years. The most common type of evidence for guidelines was randomized controlled trials (26.9%). The citation of systematic reviews was only 12.0%. Conclusions Most of the Chinese guidelines published in 2019 did not have clear and unambiguous recommendations. Those guidelines with clear recommendations had incomplete and untimely evidence citations. Guideline developers should strengthen the rational use of currently available research evidence.

Objective To analyze the situation of funding and conflicts of interest of Chinese clinical practice guidelines published in medical journals in 2019, so as to provide reference for the standardized management of funding and conflicts of interest in Chinese guidelines. Methods We systematically searched four electronic databases and additional sources for Chinese guidelines published in medical journals from January 1 to December 31, 2019. After screening, two researchers independently extracted data on funding and conflicts of interest and cross checked. We analyzed data by using EndNote X9, Microsoft Excel 2019 and SPSS 25.0 software. Results We finally included 226 guidelines, of which, 187 were published in Chinese and 39 in English. There were 68 (30.1%) and 120 (53.1%) guidelines that reported funding and conflicts of interest, respectively, and only 41 (18.1%) that reported on both. There were 64 (28.3%) guidelines reported to have received funding, involving 170 projects, which were mainly at the national level (82, 48.2%) and ministerial and provincial-level (52, 30.6%). Only 5 (2.2%) guidelines reported the role of the funder in the stages of the development process. Among the 120 guidelines that reported conflicts of interest, 102 (85.0%) simply described 'no conflicts of interest', while there were less than 10% of guidelines that reported the methods of collection, assessment and management for conflicts of interest, and there was no public access available to such information. Conclusions There is a lack of effective management of funding and conflicts of interest in the Chinese guidelines published in medical journals in 2019, which is reflected in the low reporting rate, insufficient reporting contents and unavailable materials provided by the guideline developers. We suggest that guideline developers in the future should pay more attention to the field of guideline funding and conflicts of interest. Guidelines managers and researchers should actively improve management policies, and develop relevant reporting standards.

Chemodynamic therapy (CDT) is a kind of anti-tumor strategy emerging in recent years, but the concentration of hydrogen peroxide (H2O2) in the tumor microenvironment is insufficient, and it is difficult for a single CDT to completely inhibit tumor growth. Here, we designed a CuS nanoparticles (NPs) and camptothecin (CPT) co-loaded thermosensitive injectable hydrogel (SCH) with self-supplied H2O2 for enhanced CDT. SCH is composed of CuS NPs and CPT loaded into agarose hydrogel according to a certain ratio. We injected SCH into the tumor tissue of mice, and under the irradiation of near-infrared region (NIR) laser at 808 nm, CuS NPs converted the NIR laser into heat to realize photothermal therapy (PTT), and at the same time, the agarose hydrogel was changed into a sol state and CPT was released. CPT activates nicotinamide adenine dinucleotide phosphate oxidase, increases the level of H2O2 inside the tumor, and realizes the self-supply of H2O2. At the same time, CuS can accelerate the release of Cu2+ in an acidic environment and light, combined with H2O2 generated by CPT for CDT treatment, and consume glutathione in tumor and generate hydroxyl radical, thus inducing tumor cell apoptosis. The SCH system we constructed achieved an extremely high tumor inhibition rate in vitro and in vivo, presenting a new idea for designing future chemical kinetic systems.

In hydraulic mechanical transmission loaders, a hydraulic torque converter can prevent an engine from stalling due to overloading of the loader during the spading process; however, the hydraulic torque converter also reduces the loader’s fuel economy because of its low transmission efficiency. To address this issue, the study designs an output-power-split transmission system that is applied to a hybrid loader. The designed transmission system removes the hydraulic torque converter in the power transmission system of a traditional loader and adopts a planetary gear set with a compact structure as the dynamic coupling element, thus allowing the output power of the loader to be split transmitted. During shoveling, the loader power-split transmission system based on a planetary gear set can prevent the motor from plugging and over-burning under conditions that ensure that the traction does not decrease. In addition, the transmission efficiency and loader fuel economy are higher in the proposed transmission system than in the power transmission system of a traditional loader. The test results show that the transmission efficiency of the designed system was 13.2% higher than that of the traditional hydraulic mechanical transmission loader.

The general question this research investigates concerns the difference between the use of lexical bundles in a corpus of abstracts for theses in the liberal arts written by Chinese undergraduate students and a corpus of abstracts written by American master's degree students. The undergraduate abstracts were first written in Chinese and then translated in to English at a medium-sized university in China. The master's degree theses abstracts were downloaded from an online database. It was found that there were differences in the types and tokens of lexical bundles in the two corpora with few shared bundles. There were fewer differences in the structural characteristics and in the functions of the lexical bundles found in the two corpora. Specific pedagogical recommendations are made, as well as implications regarding methodology in future research.