Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine （Part 8）： Quality Evaluation with AGREE Ⅱ and RIGHT / 中医杂志

ObjectiveTo evaluate the methodological and reporting quality of clinical practice guidelines for Chinese patent medicine （CPM） with internationally recognized tools the appraisal of guidelines for research and evaluation （AGEREE） Ⅱ and reporting items for practice guidelines in healthcare （RIGHT）， thereby providing refe-rence for the clinical application and future development of CPM guidelines. MethodsDatabases including CNKI， VIP， Wanfang and Sinomed were searched for CPM guidelines， as well as medlive.cn， websites of China Association of Chinese Medicine and Chinese Medical Association， and reference lists of the included papers. The quality of the guidelines was evaluated using the AGREE Ⅱand RIGHT tools， and consistency tests were performed using Interclass Correlation Coefficient， and descriptive analysis and chi-square test were used to analyze the reporting rate for each domain and the average score for each item. ResultsFinally， 140 CPM guidelines were included， of which 51 were disease-oriented and 89 were drug-oriented， all of which were issued by China. For 51 disease-oriented CPM guidelines， the highest average score of all six AGREE Ⅱ domains was 73.32% for clarity， and the lowest was 26.80% for application； for 89 drug-oriented CPM guidelines， the highest average score was 55.62% for scope and purpose， and the lowest was 31.32% for rigour of development. In terms of the seven domains of the RIGHT checklist， the highest reporting rate was 68.26% for background， and lowest was 27.45% for other areas regarding the disease-oriented CPM guidelines； the highest reporting rate was 61.31% for background， and the lowest was 4.49% for other areas regarding drug-oriented CPM guidelines. The average reporting rate was higher for disease-oriented than drug-oriented CPM guidelines in three domains of AGREE Ⅱ （rigour of development， clarity of presentation， editorial independence）， as well as four domains of RIGHT checklist （basic information， evidence， funding and declaration and management of interests， and other areas）. ConclusionThe overall methodology and reporting quality of the current CPM guidelines still need to be improved. It is recommended that future guideline development teams should strictly refer to the AGREE Ⅱ and RIGHT checklist， and take into account of the characteristics of CPM guidelines and relevant methodo-logical suggestions in the development and reporting of CPM guidelines， thereby guiding the clinical use of CPM in a better way.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine （Part 7）： Introduction and Interpretation of the Guideline Reporting Checklist / 中医杂志

The systematic and comprehensive introduction and interpretation of the Reporting Checklist of Clinical Practice Guidelines for Chinese Patent Medicines V1.0 is conducive to the presentation of high-quality clinical practice guidelines for Chinese patent medicines （CPMs）， thus improving their dissemination and use. The Reporting Checklist of Clinical Practice Guidelines for Chinese Patent Medicines V1.0 specifies the requirements for clear， complete and transparent reporting of the whole process of developing CPMs guidelines， containing 4 domains， 17 topics and 43 items， and involving the basic information， recommendations and methods of guideline development. Especially， it details the items related to the rules and regulations of the use of CPMs in the recommendations， which is helpful for improving the completeness， scientificity and practicality of the reporting of CPMs guideline.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine （Part 6）： Formation and Presentation of Recommendations / 中医杂志

Recommendation formation is a key component of clinical practice guidelines for Chinese patent medicine （CPM）， and should encompass the determination of the strength and direction of the recommendation， the rationale for the recommendation， and the methodology for implementing the recommendation. Recommendations can be formed through formal consensus and informal consensus. The strength and direction of recommendations for CPM guidelines should be determined by considering the quality of evidence for CPMs， the priority of the clinical questions， the pros and cons of efficacy and adverse effects， patient acceptance， the feasibility of the recommendation and the availability of resources， social fairness， economic benefits， and other influencing factors. In order to better guide guideline developers to consider these factors more rationally， this article provideed a detailed explanation of each factor in the context of the characteristics of TCM.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine（Part 5）： Retrieval and Synthesis of Key Information on Rational Drug Use / 中医杂志

Recommendations for Chinese patent medicine （CPM） based on key information on rational drug use are one of the important conditions for enhancing guideline enforceability as well as facilitating guideline implementation. In this study， we discussed in detail of the key information on the rational use of CPM in five aspects， which are dosage， drug discontinuation， drug-drug and drug-food interactions， safety and economy. Following the process of multi-source search， synthesis and prioritization， it is suggested to collect key information on the rational use of CPM from a multi-source search of drug instructions， policy documents， literature， and clinical experts' experiences. Then the searched information should be summarized and prioritized with the principle that taking drug instructions as the basis and other-sources information for check and supplementation. Finally， methodological recommendations for the retrieval and synthesis of key information on rational drug use in guideline recommendations has been formed.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine（Part 4）： Evidence Retrieval and Evaluation / 中医杂志

The retrieval and evaluation of evidence is the basis for the development of clinical practice guidelines for Chinese patent medicine. As traditional Chinese medicine has a different development trajectory and utilization characteristics from modern medicine， there is certain differences in terms of evidence composition， retrieval and integration.This paper discussed multi-source body of evidence on Chinese patent medicine based on modern evidence-based medicine and ancient medical literature， and summarized the retrieval strategy as well as the possible problems and solving methods. For different types of evidence on Chinese patent medicine， the corresponding evaluation tools have been recommended， and the order to integrate the evidence based on the quality of the evidence from high to low is suggested. Finally， a multi-source based evidence retrieval-evaluation-integration scheme for Chinese patent medicine has been formed， which will provide a methodological reference for practitioners in the development of clinical practice guidelines for Chinese patent medicine.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine（Part 3）： Identification of Clinical Questions / 中医杂志

The identification of clinical questions for clinical practice guidelines of Chinese patent medicine （CPM） is important for subsequent evidence retrieval， evaluation of evidence quality， formation of recommendations. This paper described a methodological proposal for the identification of clinical questions for CPM guidelines to highlight the characteristics of Chinese patent medicine and reflect its effect in specific stage of the disease. Considering four aspects， namely， the drug of Chinese patent medicine （D）， the specific disease stage （S）， comparison （C）， and specific outcome （O）， DSCO framework has been proposed to formulate the clinical questions. Multi-source information through scientific research， policy or standard documents， and clinical data are suggested for collecting clinical questions， and clear selection criteria should be set to finalize the clinical questions to be addressed by the guideline. In addition， the above process needs to be transparently and publicly reported in order to ensure the clarity and completeness of the guidelines.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine： 2.Establishment of Guideline Working Group and Management of Conflict of Interests / 中医杂志

This paper summarized the key points and methods in terms of the establishment of the guideline working group and the management of conflict of interests， trying to provide reference for the development of clinical practice guidelines for Chinese patent medicine （CPM）. The establishment of the working group is the first important step for developing CPM guidelines. Considering the characteristics of the clinical practice guidelines for CPM， this study suggests that the three key elements of ‘multidisciplinarity’， ‘clinical relevance’ and ‘geographical representativeness’ should be put focus on when forming the working group. The guideline advisory committee， clinical expert group， evidence systematic evaluation group， secretary group and the external review group should be established. All group members should clarify the conflict of interest， and the process and management method of the conflict of interest should be clearly reported.

Methodology for the Development of Clinical Practice Guideline for Chinese Patent Medicine（Part 1）： Development Status and Characteristics / 中医杂志

The irrational use of Chinese patent medicines （CPM） is becoming more and more prominent， which makes the demand for clinical practice guidelines of CPM gradually increase. In order to make domestic scholars understand the latest developments and existing problems of the CPM guidelines， and promote its development， this paper introduced the concept of CPM guidelines， summarized the characteristics of the two development modes， namely “taking CPM as the key” and “taking disease/syndrome as the key”， and analyzed the current methodological status of developing and reporting CPM guidelines. Based on the existed problems， three suggestions have been put forward to optimize the quality of CPM guidelines， which were clarifying the target users and scope of CPM guidelines， establishing an open and transparent mechanism of the personnel involvement and process steps， and formulating implementable and operable recommendations for the use of CPM.

Investigation and Analysis on Curriculum Design for Undergraduate Nursing Majors in TCM Colleges and Universities / 中国中医药信息杂志

Objective To investigate the differences of curriculum designs for undergraduate nursing majors among different TCM colleges and universities;To provide evidence for the development of the accreditation standards for academic quality of baccalaureate degree program in TCM colleges and universities which can be used as the standards for teaching reform. Methods Cultivating plans of 20 TCM colleges and universities for undergraduate nursing majors were collected. Current status and deficiency in curriculum design were obtained through comparative study and statistical analysis.Results The course names were lack of standardization;proportion of Chinese and Western medicine related courses were unreasonable;theoretical and practice teaching were irrelevant;optional courses were greatly inconsistent and irrational. Conclusion The further reform of the curriculum design for the undergraduate nursing majors in TCM colleges and universities is in urgent need, which can be standardized by developing the accreditation standards for academic quality of baccalaureate degree program in universities of Chinese Medicine.

Investigation on Knowledge, Attitude and Practice of Exercise for Post-operative Breast Cancer / 中国康复理论与实践

Objective To investigate knowledge, attitude, and practice of exercise for post-operative breast cancer. Methods 110 post-operative breast cancers were investigated using a self-designed questionnaire which included general condition of patients, knowledge, atti-tude and practice of exercise after breast surgery. Results The rate of effective response was 98%. The average rate of awareness about post-operative exercise for breast cancers was 87%, and the score of knowledge of intensity and forms of exercise was the lowest, while the an-nouncements of post-operative exercise was the highest. All of the patients presented positive attitude toward exercise, however, some of them indicated that they couldn't insist on it. 41%exercised only in one form, 78%at a low intensity, 41%less than 3 times per week, and 74%at least 30 minutes per session. Only 7%did traditional Chinese medical exercise. Time after surgery correlated positively to general scores (r=0.40, P<0.01), kinds of exercise (r=0.41, P<0.05) and intensity of exercise (r=0.43, P<0.05). Phase of cancer correlated negatively to general scores (r=-0.37, P<0.05) and exercise time (r=-0.38, P<0.05). Conclusion The knowledge on intensity and form of exercise af-ter operation is not popular in post-operative breast cancers.

Investigation on Knowledge, Attitude and Practice of Exercise for Post-operative Breast Cancer / 中国康复理论与实践

@#Objective To investigate knowledge, attitude, and practice of exercise for post-operative breast cancer. Methods 110 postoperative breast cancers were investigated using a self-designed questionnaire which included general condition of patients, knowledge, attitude and practice of exercise after breast surgery. Results The rate of effective response was 98%. The average rate of awareness about postoperative exercise for breast cancers was 87%, and the score of knowledge of intensity and forms of exercise was the lowest, while the announcements of post-operative exercise was the highest. All of the patients presented positive attitude toward exercise, however, some of them indicated that they couldn't insist on it. 41% exercised only in one form, 78% at a low intensity, 41% less than 3 times per week, and 74% at least 30 minutes per session. Only 7% did traditional Chinese medical exercise. Time after surgery correlated positively to general scores (r=0.40, P<0.01), kinds of exercise (r=0.41, P<0.05) and intensity of exercise (r=0.43, P<0.05). Phase of cancer correlated negatively to general scores (r=-0.37, P<0.05) and exercise time (r=-0.38, P<0.05). Conclusion The knowledge on intensity and form of exercise after operation is not popular in post-operative breast cancers.

Effect of Tai Chi on Quality of Life of Patients with Breast Cancer:A Systematic Review of Randomized Controlled Trials / 中国康复理论与实践

Objective To evaluate the effectiveness of Tai chi on quality of life of breast cancer patients. Methods Articles from 10 Eng-lish and Chinese Databases from inception to March 2012 were recalled. 2 researchers independently screened titles and abstracts for eligi-ble trials, methodological quality was assessed according to risk of bias items. Meta-analysis would be used if data available. Results 4 ran-domized trials with 169 participants were included. All trials had high risk of bias. 2 studies demonstrated significant improvement in Tai chi group for improving shoulder functional capacity which caused by breast cancer. The meta-analysis failed to demonstrate significant effects of Tai chi compared with control interventions (psychological support therapy, standard health care, routine rehabilitation training) in im-proving quality of life (SMD 0.03, 95%CI:-0.85, 0.91, P=0.94). Conclusion Tai chi is effective on shoulder functional capacity of breast cancer, but not significantly on quality of life.