Chronic heart failure (CHF) is a global public health problem. Therefore, novel and effective drugs that show few side-effects are needed. Early literature studies indicated that Huangqi injection is one of the most commonly used traditional Chinese patent medicines for CHF in China. As a large number of clinical studies has been carried out and published, it is essential to evaluate the effectiveness and safety of Huangqi injection. Therefore, we carried out this systematic review under the support of the framework of the Joint Sino-Italian Laboratory (JoSIL). To evaluate the efficacy and safety of Huangqi injection for CHF according to the available scientific knowledge. An extensive search including PubMed, EMBASE, CBM, the Cochrane Library and Chinese literature databases was performed up to July 2008. Clinical trials regarding Huangqi injection for the treatment of CHF were searched for, irrespective of languages. The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0, and RevMan 5.0 provided by the Cochrane Collaboration and STATA 9.2 were used for data analysis. After selection of 1,205 articles, 62 RCTs and quasi-RCTs conducted in China and published in Chinese journals were included in the review. The methodological quality of the trials was low. In most trials inclusion and exclusion criteria were not specified. Furthermore, only one study evaluated the outcomes for drug efficacy after an adequate period of time. For these reasons and because of the different baseline characteristics we did not conduct a meta-analysis. Although available studies are not adequate to draw a conclusion on the efficacy and safety of Huangqi injection (a traditional Chinese patent medicine), we hope that our work could provide useful experience on further studies on Huangqi injections. The overall level of TCM clinical research needs to be improved so that the efficacy of TCM can be evaluated by the international community and possibly some TCM can enter into the international market.

Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46–91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28–0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.

Background and Purpose— For its current dimensions, stroke represents the world’s primary health challenge. In China stroke is the second most common cause of death. Traditional Chinese Medicine (TCM) has for many centuries been used, and it is still widely used today in countries of south and east Asia for the treatment of people with stroke. The objective of this systematic review was to evaluate whether complex Traditional Chinese Medicine (cTCM) improves poststroke motor recovery. In particular, we defined cTCM as intervention that included at least acupuncture and Chinese herbal medicine. Methods— An extensive search including PubMed, EMBASE, CBM, and the Cochrane Library was performed up to December 2007. Randomized clinical trials (RCTs) about cTCM for motor dysfunction of poststroke were searched irrespective of any language. The quality of each trial was assessed according to the Cochrane Reviewers’ Handbook 4.2.6. Results— After selection of 11 234 articles, 34 RCTs and quasi-RCTs were included. All these trials were conducted in China and published on Chinese journals. All trials but one reported results in favor of cTCM treatments suggesting a strong publication bias. Because of the significant clinical and methodological heterogeneity, no meta-analysis was performed and thus no cumulative result was obtained pooling data of RCTs. Conclusions— What appears from this systematic review is that scant data are available to evaluate efficacy of cTCM for poststroke motor dysfunction. Most of the primary studies available for this review were inadequately designed trials characterized by unknown dropout rates and definitional vagueness in outcomes measures. None of the studies approached important end points like death, survival times, rate of dependency, reduction in length of stay in hospital, etc. The key to lead to evidence-based practices is establishing a consensus on standardized relevant outcome measures and then designing and conducting appropriate RCTs that adopt those standards.

Objective: Generative artificial intelligence (AI) technology, represented by large language models (LLMs), has gradually been developed for traditional Chinese medicine (TCM); however, challenges remain in effectively enhancing AI applications for TCM. Therefore, this study is the first systematic review to analyze LLMs in TCM retrospectively, focusing on and summarizing the evidence of their performance in generative tasks. Methods: We extensively searched electronic databases for articles published until June 2024 to identify publicly available studies on LLMs in TCM. Two investigators independently selected and extracted the related information and evaluation metrics. Based on the available data, this study employed descriptive analysis for a comprehensive systematic review of LLM technology related to TCM. Results: Ten studies published between 2023 and 2024 met our eligibility criteria and were included in this review, including 40% LLMs in the TCM vertical domain, 40% containing TCM data, and 20% honoring the TCM contribution, with a foundational model parameter range from 1.8 to 33 billion. All included studies used manual or automatic evaluation metrics to evaluate model performance and fully discussed the challenges and contributions through an overview of LLMs in TCM. Conclusions: LLMs have achieved significant advantages in TCM applications and can effectively address intelligent TCM tasks. Further in-depth development of LLMs is needed in various vertical TCM fields, including clinical and fundamental research. Focusing on the functional segmentation development direction of generative AI technologies in TCM application scenarios to meet the practical needs-oriented demands of TCM digitalization is essential. Graphical https://links.lww.com/AHM/A152 . Export

Clinical or care pathways are developed by a multidisciplinary team of healthcare practitioners, based on clinical evidence, and standardized processes. The evaluation of their framework/content quality is unclear. The aim of this study was to describe which tools and domains are able to critically evaluate the quality of clinical/care pathways. An overview of systematic reviews was conducted, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Science Citation Index, PsychInfo, CINAHL, and Cochrane Library, from 2015 to 2020, and with snowballing methods. The quality of the reviews was assessed with Assessment the Methodology of Systematic Review (AMSTAR-2) and categorized with The Leuven Clinical Pathway Compass for the definition of the five domains: processes, service, clinical, team, and financial. We found nine reviews. Three achieved a high level of quality with AMSTAR-2. The areas classified according to The Leuven Clinical Pathway Compass were: 9.7% team multidisciplinary involvement, 13.2% clinical (morbidity/mortality), 44.3% process (continuity-clinical integration, transitional), 5.6% financial (length of stay), and 27.0% service (patient-/family-centered care). Overall, none of the 300 instruments retrieved could be considered a gold standard mainly because they did not cover all the critical pathway domains outlined by Leuven and Health Technology Assessment. This overview shows important insights for the definition of a multiprinciple framework of core domains for assessing the quality of pathways. The core domains should consider general critical aspects common to all pathways, but it is necessary to define specific domains for specific diseases, fast pathways, and adapting the tool to the cultural and organizational characteristics of the health system of each country.

Il concetto di patient engagement ha assunto crescente attenzione in sanità. Gli ultimi decenni, infatti, hanno visto un viraggio profondo dei modelli di cura verso una sempre maggiore valorizzazione del ruolo della persona, vista come soggetto attivo ed “esperto” all’interno del processo clinico-assistenziale. D’altro canto, i sistemi sanitari si trovano a interloquire con persone che esprimono il desiderio di avere un ruolo più attivo in tutte le fasi del percorso sanitario e di conoscere in maniera approfondita tutte le possibili opzioni di trattamento, i relativi vantaggi e i rischi. Tuttavia, sebbene i ricercatori e i clinici siano d’accordo circa della promozione del patient engagement, a oggi manca un consenso circa le strategie e gli strumenti più idonei per il raggiungimento di questo obiettivo. Le prospettive dei pazienti e degli operatori sanitari sui fattori che possono sostenere o, per contro, ostacolare il patient engagement non sono state ancora sufficientemente studiate e, attualmente, non esistono chiare raccomandazioni sugli interventi più efficaci. Sulla base di queste premesse, l’Università Cattolica di Milano e la Regione Lombardia, sotto la supervisione metodologica dell’Istituto Superiore di Sanità, hanno promosso una conferenza di consenso dal titolo: “Raccomandazioni per la promozione del patient engagement in ambito clinico-assistenziale per le malattie croniche”, che ha costituito un ambiente di scambio e di discussione tra esperti appartenenti a diversi contesti clinici e istituzionali e rappresentanti di associazioni di pazienti, al fine di identificare buone pratiche e strumenti efficaci per promuovere il patient engagement in ambito clinico-assistenziale per le malattie croniche.