ObjectivesTo investigate the current status of the clinical applicability evaluation tools, and to provide some foundation for establishment of the clinical applicability evaluation index system.Methods7 databases, 6 guideline databases and 16 academic institutions and the administrative department of health website were systematically searched from inception to April 2019. Two reviewers independently screened literature, extracted data and then included the literature related to the applicability of clinical guidelines. The CPG clinical applicability evaluation index was initially prepared through the subject comprehensive method.ResultsA total of 19 articles were finally included. Among them, there were 4 evaluation tools for the clinical applicability of the guidelines, and 15 evaluation tools for the guideline clinical applicability evaluation items. Through combing and comparison, we found that these tools had differences in evaluators, evaluation fields and items.ConclusionsThe global guidelines for clinical applicability assessment tools have different kinds of problems, such as that the tools are not targeted, the indicators are not well-formed, and the methodological knowledge requirement of the evaluators is high. There is still a lack of guidelines for clinical applicability assessment tools from target users’ view.
ObjectiveTo investigate the drug utilization in primary healthcare system of Xinjin county of Chengdu in 2010.
MethodsThe drug utilization information in regional health information platform of Xinjin county were collected. Microsoft Excel 2003 software was used to describe the types, forms and expenditure of medicines, particularly the use of antibiotics among outpatients and inpatients.
ResultsThe drug utilization of 17 hospitals in Xinjin county in 2010 was summarized below:a) there were 1 507, 1 356 and 695 kinds of drugs dispended for outpatients, and 1 271, 1 023 and 317 for inpatients in county-level hospitals (CLH), township hospitals (TH) and community healthcare centre (CHC), respectively. Among which, oral biomedicine and traditional Chinese medicine (TCM) accounted for about 45% of total types, and 46% to 73% of total drug expenditure among outpatients; while oral biomedicine and the injection accounted 37% to 61% of total types of medicines dispended to inpatients, particularly injection of biomedicine accounting for over 75% of total drug expenditure among inpatients. b) The expenditure of top 30 drugs in primary care hospitals accounted for 50% of total drug expenditure among outpatients and over 85% among inpatients. c) Among the top 20 drugs, there were 15 antibiotics, which accounted for 26.5% of total drug expenditure in Xinjin county. The top 10 antibiotics were mainly cephalosporin, accounting for 59.36% and 66.27% of total antibiotics expenditure among outpatients and inpatients respectively.
Conclusiona) The main forms of medicines dispended to outpatients are oral biomedicine and TCM, while oral agents and injection of biomedicine are the majority of medicines used for inpatients. b) The top 30 drugs should be monitored for rational use of drugs considering the huge expenditure. And c) the types, proportion of use and expenses of antimicrobial drugs ranked the first in CLH, CHC and TH, which may imply irrational use of antibiotics.
Objective
To investigate the correlation between the initial arterial blood lactic acid and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score in trauma patients and its value in prognosis.
Methods
From August 1st 2015 to July 31st 2016, the clinical data of trauma patients treated in Department of Emergency were analyzed retrospectively. All patients were divided into survival group and death group by observing 28-day prognosis. We compared the relationship between the initial blood lactate level and APACHEⅡ score, and analyzed the relationship between the above indexes and the prognosis of the patients.
Results
A total of 743 patients were enrolled, with692 in survival group and 51 in death group.The APACHEⅡ score and initial blood lactate level in the survival group [(9.93±4.62) points, (2.02±1.44) mmol/L] were significantly lower than those in the death group [(22.84±7.26) points, (4.60±3.69) mmol/L] with significant differences (t=18.20, 9.77; P<0.01). The APACHEⅡ score and the mortality rate of patients with lactic acid level >4 mmol/L were significantly higher than those of patients with lactic acid of 2-4 mmol/L and <2 mmol/L; the differences were significant (P<0.05). The blood lactate and mortality in patients with APACHEⅡ score >20 were significantly higher than those in the patients with ≤10 and 11-20; the differences were significant (P<0.05). There was a significant positive correlation between initial blood lactate level and APACHEⅡ score (r=0.426, P<0.01).
Conclusions
The initial blood lactate level and APACHEⅡ score of trauma patients are correlated with the severity of injury and mortality. Both of the increase of initial blood lactic acid level and APACHEⅡ score suggest the risk of death in trauma patients.
ObjectivesTo analyze the current methodological and reporting quality of both domestic and overseas clinical practice guidelines on acupuncture, and to provide reference for the development of high quality acupuncture clinical practice guidelines.MethodsGIN, NICE, AHRQ, PubMed, EMbase, AMED, CINAHL, WanFang Data, CNKI, VIP and CBM databases were electronically searched to collect domestic and overseas clinical practice guidelines on acupuncture from inception to September, 2018. Two reviewers independently screened literature, extracted data and evaluated the methodological and reporting quality by using AGREE Ⅱ and RIGHT tools.ResultsA total of 23 acupuncture clinical practice guidelines were included, in which three were developed by foreign institutions, and the remaining 20 guidelines were jointly developed by WHO Western Pacific Region and China Institute of Acupuncture and Moxibustion. Three foreign and two domestic guidelines were selected for evaluation. The AGREE Ⅱ evaluation showed that the domestic guidelines have higher scores in terms of " scope and purpose”, " stakeholder involvement”, " rigor of development”, " applicability” and " clarity of presentation”, while only " editorial independence” is lower. The overall recommendation is stronger than the foreign guidelines. The RIGHT evaluation showed that for three foreign guidelines, the " reported” items accounted for 52.38%, " unreported” items accounted for 38.09%, " partly reported” items accounted for 6.66%%; however, for domestic guidelines, the " reported” accounted for 45.71%, " unreported” items accounted for 40%, and " partly reported” items accounted for 14.28% respectively. Overall, the difference is not significant (SD<10%). Due to the specificity of acupuncture interventions, the use of AGREEⅡ and RIGHT to evaluate acupuncture clinical practice guidelines still had barriers to some extend on its applicability.ConclusionThe methodological and reporting quality of acupuncture clinical practice guidelines are relatively low. It is urgent to further improve the methodological level and reporting standards of the guidelines, and to develop evaluation tools for the acupuncture field guidelines.
ObjectivesThis study aimed to analyze the evaluation data of 24 professional residency training bases of West China Hospital of Sichuan University(WCHSCU) so as to provide experience for construction of residency training base.MethodsBased on the evaluation criteria of standardized residency professional bases published by Chinese Medical Association in 2019, 24 professional bases of residency training in WCHSCU were evaluated in terms of base condition, teaching staff and process management.ResultsThe results showed that 41.67% of the 24 residency bases received a total score above 90 points, 16.67% were between 85 to 90 points, 20.83% were between 80 to 85 points, 8.33% were between 70 to 80 points, and 12.50% were between 60 to 70 points.ConclusionsThe residency training base construction of (WCHSCU) is satisfactory.
Objective To establish and evaluate the hind limb ischemia model in type 2 diabetic rats， and to providea platform for subsequent intervention experiment. Methods Fifteen SD rats were randomly divided into 3 groups：normal control group， diabetes group， and diabetic ischemia group， each group enrolled 5 rats. The 10 rats of later 2 groups were fed with high fat diet for 4 weeks， and then received intraperitoneal injection of streptozotocin （40 mg/kg） to establish type 2 diabetic model. Three days later， the rats of diabetic ischemia group underwent ligation of the bilateral common iliac artery to establish the hind limb ischemia model， but iliac artery of rats in other 2 groups didn’t received ligation. Ultrasound and color Doppler flow imaging detection was used to determine the peak velocity and acceleration time of femoral artery in rats of 3 groups in 2 weeks after operation， and triceps tissues and quadriceps tissues were collected to perform HE staining and SP staining for the observation on status of nutrition and vascular regeneration respectively. Results The peak velocity of femoral artery in rats of normal control group， diabetes group， and diabetic ischemia group were （22.49±3.02） cm/s， （17.36±2.60） cm/s， and （11.23±1.26） cm/s， the acceleration time were （0.080±0.009） s，（0.120±0.009）s， and（0.160±0.020） s， the arteriolar density measured by immunohistochemistry SP method were 6.80±0.84/HPF， 4.60±0.55/HPF， and 1.40±0.55/HPF respectively. The peak velocity of femoral artery and arteriolar density of rats in diabetic ischemia group were both lower （P＜0.05）， but acceleration time was longer （P＜0.05）. Results of HE staining showed that structure of triceps tissues was damaged， with infiltration of lots of inflamm-atory cells， which was worse than normal control group and diabetes group. Conclusion Method of high-fat diet in combination with small dose of streptozotocin can induce type 2 diabetic rat model， and hind limb ischemia model can be successfully established by ligation of common iliac artery on this model.
With the flourishing career of scientific research, the number of medical literature is in the explosion of growth. According to the statistics revealed by the Royal Society in March 2011, it showed that the proportion of published literature in China increased from 4.4% at the beginning of this century to 12.2%, and leaped into the second rank of the world. But the citations lagged behind the growth in number. In addition, the quality of medical literature relates to the reliability of results. Therefore, how to evaluate and improve the quality of medical literature is important. This paper will present some evaluation methods of credible medical literatures.
The background and status of the quality assessment instruments of clinical trials, and several frequently used instruments both domesticly and abroad were introduced, and the problems in this field were discussed.
Protein-energy wasting is one of the common complications of maintenance hemodialysis patients. It often causes decreased immune function, increased anemia, and decreased heart, brain, lung and other organ functions, resulting in decreased quality of life, decreased long-term survival rate, and increased mortality. This article discusses the causes, diagnosis, evaluation methods, intervention and prevention of protein-energy wasting in maintenance hemodialysis patients, and aims to provide a theoretical basis for evaluating the nutritional status, early intervention for protein-energy wasting, and improving prognosis and quality of life of maintenance hemodialysis patients.
Objective To introduce the evidence-based evaluation on off-label uses at home and abroad, so as to investigate a systematic method of evidence-based evaluation on off-label uses. Methods In combination with the domestic and international research literature, a systematic method of evidence-based evaluation on off-label uses was discussed from the following three aspects: sources of evidence, levels of evidence, and recommendation strength. Results Sources of evidence included Clinical Pharmacology, DRUGDEX? System, NCCN Drugs amp; Biologics Compendium and handsearched literature. Levels of evidence and recommendation strength could refer to the 2009 grade system of Oxford Centre for Evidence-Based Medicine, and the strength of recommendations and scientific support of DRUGDEX? System. Conclusion A systematic method of evidence-based evaluation on off-label uses is initially established.
