Differences in Contents and Formation Methods of Clinical Questions in Chinese and Korean Clinical Practice Guidelines of Acupuncture-Moxibustion: Scoping Review.

OBJECTIVE: To analyze the differences in the needs of users and the value orientation of clinical practice guidelines (CPGs) by comparing the contents and formation methods of clinical questions in Chinese and Korean CPGs of acupuncture-moxibustion (Acup-Mox). METHODS: The full text of CPGs was systematically searched from the official websites of Chinese and Korean traditional medicine societies and Acup-Mox associations, with the topic "Acup-Mox for treating diseases" and the retrieval time up to September 28, 2022. Two researchers screened the CPGs independently, and extracted the guidelines' topics, content, quantity and formation methods of clinical questions. The quantitative data were collected by counting the frequency, and the qualitative data were classified and described by thematic analysis. RESULTS: A total of 29 guidelines were included in this study, including 20 Chinese guidelines (305 questions) and 9 Korean guidelines (223 questions). The differences lie in the aspects of content and diversity, and formation method. As for content and diversity, Chinese guidelines focused mainly on the questions related to treatment such as the operation of specific intervention (86, 28.2%), efficacy of intervention (78, 25.6%), and also involving questions in diagnosis, prevention, and prognosis. While the clinical questions in Korean guidelines were concentrated to efficacy of intervention (218, 97.8%). As for formation method, in Chinese guidelines, questions were usually collected directly from clinicians, and then determined and optimized by experts. In Korean guidelines, frequently used clinical Acup-Mox interventions would be screened first. Then the expert group would set up corresponding intervention control measures so as to form clinical questions related to treatment efficacy. CONCLUSIONS: The differences reflect the different needs of clinical practitioners, and the different aims or concepts in developing Acup-Mox guidelines between China and South Korea. Chinese guidelines emphasized promoting operation protocols and techniques of Acup-Mox for practical use, while Korean guidelines emphasized promoting the frequently used clinical intervention therapies. It is speculated that the guidelines from these two countries would play different roles in guiding clinical operation and supporting medical decision. In terms of formation methods of clinical questions, it is suggested to attach importance to optimizing process in formatting clinical questions to improve the clinical applicability of CPGs of Acup-Mox.

Discussion on Collection of Clinical Questions in International Clinical Practice Guidelines of Acupuncture-Moxibustion.

The clinical questions of acupuncture-moxibustion (Acup-Mox) guidelines are complicated, including not only the curative effect of Acup-Mox intervention measures, but also the operational elements of Acup-Mox. This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines. The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions. Based on the characteristics of Acup-Mox discipline. This paper put forward the thinking of collecting elements of clinical questions following the intervention-population-outcome-control (I-P-O-C) inquiry process, according to the discipline of Acup-Mox. It was emphasized that in the process of collecting clinical questions, "treatable population" and "alleviable outcome indicators" for a specific Acup-Mox intervention with certain therapeutic effect should be focused on, so as to highlight the pertinence of clinical questions of Acup-Mox guidelines in terms of population and outcome elements.

[Analysis and thought on reaching the consensus during the development of acupuncture and moxibustion clinical practice guidelines in China].

Based on the 28 Chinese clinical practice guidelines of acupuncture and moxibustion, this study summarized and analyzed the contents related to reaching consensus during the development process. The results indicated that all the 28 guidelines reported they have used consensus in the "recommendations" section, and provided details on consensus personnel, consensus methods, consensus process and consensus materials. However, it was found that the reporting of consensus was in need of further improvement. The limitations included unclear definition and responsibilities of "expert group", obscure concept between "consensus meeting" and "expert discussion", non-rigorous process of reaching consensus when generating recommendations and lacking of detailed reporting of the consensus reaching process. As such, we suggested that future researchers should conduct researches to further standardized the consensus process when developing acupuncture and moxibustion clinical practice guidelines, so as to improve the quality and clinical applicability of guidelines．.

Impact of Video Technology on the Comprehension of Patients With First Insulin Injection and the Efficiency of Nurse Education.

This study aims to compare the effectiveness of video and paper materials used for teach-back education on the first insulin injection for patients with diabetes. The study enrolled 110 patients hospitalized for diabetes who had received education on their first insulin injection in the endocrinology department. The patients were divided into an intervention group (n = 55) and a control group (n = 55) using convenience sampling. Video materials were employed for the teach-back education of the intervention group, while paper materials were employed for the teach-back education of the control group. We compared cases who answered correctly to the common parts (selection and management of injection devices, selection and rotation of injection sites, proper use of injection angles and pinching, insulin storage, injection-related complications and their prevention, selection of the correct needle length, and safe disposal of needles after use) for the first time, the number of educational sessions and total education duration between the two groups and employed the "My View on Insulin" questionnaire to survey the two groups before and 28 days after the intervention. The intervention group had a shorter total education duration than the control group, a difference that was statistically significant (p < .001). The intervention group had more advantages over the control group in terms of rotation education at the injection site (p < .05). There was no statistically significant difference in the questionnaire scores between the two groups after the intervention (p > .05); however, both groups scored significantly higher than before the intervention, a difference that was statistically significant (p < .001). The teach-back method combined with video materials applied for educating patients on their first insulin injection could reduce the education duration by healthcare providers and improve the patients' psychological insulin resistance. The key to successfully teaching patients to self-administer insulin, and allowing them to master the steps involved, is to focus on "why" rather than "what" to do.

[Investigation and analysis on the current situation of clinical practice guidelines for acupuncture and moxibustion at home and abroad].

To provide directional suggestions for the establishment of international clinical practice guidelines for acupuncture and moxibustion by investigating the current situation of clinical practice guidelines for acupuncture and moxibustion at home and abroad. The clinical practice guidelines were obtained by questionnaire survey, database retrieval and experts consulting. The guidelines were read carefully, and the content was analyzed. A total of 27 acupuncture-moxibustion clinical practice guidelines were retrieved, of which most of the guidelines came from China. The definition and scope of "acupuncture and moxibustion "vary according to different guidelines; and the focus of the content and the method of establishing the guidelines are quite different, so it is very necessary to unify the formulation methods of acupuncture-moxibustion clinical practice guidelines. Chinese clinical practice guidelines for acupuncture and moxibustion were characterized by taking the ancient literature as the evidence. Excavating the value of ancient literature and clinical experience of acupuncture-moxibustion experts are the key points and difficulties in the developing of clinical practice guidelines of acupuncture and moxibustion in the future.

[Consideration on existing problems in development of clinical practice guidelines for acupuncture and moxibustion in China].

To sort out the existing problems within the published 35 evidence-based acupuncture-moxibustion clinical practice guidelines (group standards) in Chinese: the development methods and the development process are not clear and strict enough; the evidence evaluation system fails to fully reflect the characteristics of acupuncture and moxibustion. Therefore, Norms for Formulation and Evaluation of the Guidelines on Clinical Practice of Acupuncture-Moxibustion, should require the guideline developers to consider the characteristics of acupuncture discipline, evaluate modern literature evidence comprehensively, and integrate ancient literature and medical experts' experience, to form proper recommendations for clinical practice. Specific requirements should be made simultaneously in the development process to make it clearer and stricter.

[Regulating effect of electroacupuncture on left ventricular function and autophagy-specific proteins in spontaneously hypertension rats].

OBJECTIVE: To investigate the effect of electroacupuncture (EA) on cardiac hypertrophy and expression of myocardial autophagy-specific proteins in spontaneously hypertensive rats (SHRs). METHODS: Twelve male Wistar Kyoto (WKY) rats were selected as the normal control group, and 24 male SHRs were randomized into model and EA groups (n＝12 in each). EA (2 Hz /15 Hz, 1 mA) was applied to "Taichong" (LR3) and "Baihui" (GV20) for 20 min, once a day for successive 30 days. The other two groups only received the same grasping and fixation procedures. The systolic blood pressure (SBP) was measured using a non-invasive blood detector, and the left ventricular function including the left ventricular anterior wall diameter (LVAWd), left ventricular posterior wall diameter (LVPWd) and left ventricular internal diameter at end-diastolic dimension (LVIDd) was detected using a real-time echocardiography imaging system, and the left ventricular mass index (left ventricle weight / body weight, LVMI) was calculated. The expression of Beclin-1 and LC3 proteins in the left ventricle tissue was detected by Western blot. Pathological changes of the myocardial tissue were observed by Masson staining and transmission electron microscope (TEM). RESULTS: After the intervention, the elevated SBP was significantly lowered in the EA group relevant to the model group (P<0.01) and the increased LVAWd, LVPWd and LVMI were markedly decreased in the EA group (P<0.01, P<0.05), while the reduced LVIDd was significantly ameliorated in the EA group (P<0.01). Masson staining showed that in SHRs, disorder of arrangement of cardiac myofibers, swelling of cardiomyocytes, widened space among myocardial cells with a large number of collagenous fibers were observed, and under TEM, aggregation and unequal size of myocardial mitochondria with vacuolation and rupture, autophagosomes and autophagic lysosomes were seen. These changes were relatively milder in the EA group. Western blot showed that hypertension induced up-regulation of Beclin-1 and LC3-II and ratio of LC3-II/LC3-I, and down-regulation of LC3-I were significantly suppressed in the EA group (P<0.01, P<0.05). CONCLUSION: EA at LR3 and GV20 may improve the left cardiac function, myocardial morphological changes and the degree of autophagy in SHRs, which is related to its effects in down-regulating the expression of myocardial Beclin-1 and LC3-II and in up-regulating expression of LC3-I.

[Progress of the application of PET technology in acupuncture research].

To further investigate the application of positron emission tomography (PET) technology in acupuncture research field, with "PET" and "acupuncture" as keywords, the related literature published from 1997 to 2018 was searched in PubMed, CNKI and WANFANG database; then the literature was classified and analyzed. The results showed that in clinical and experimental studies, whether in physiological or pathological conditions, PET technology has verified the specificity of acupoints, bidirectional regulation of acupoints, and the clinical effect of qi-arrival from the level of brain functional activity. It has deeply revealed the central mechanism underlying that acupuncture has multi-target, multi-channel and multi-level overall effects. The purpose of this study is to provide objective scientific basis for acupuncture research, and then potentially guide the clinical practice.