Objective To provide evidence for establishing medical specialist training system in China by evidence-based evaluation on the comparison of medical specialists training programs in different countries in Europe, America and Asia. Methods The principle and method of evidence-based science were adopted. Pubmed, official website (such as Ministry of Health, and medical board), homepages of famous medical universities or teaching hospitals and most frequently used search engines were systematically searched till Mar. 31, 2004. Included literatures were evaluated according to pre-defined standards. Results A total of 878 studies (827 in English, 51 in other languages) were included. The main contents covered clinical courses (43.3%), training quality assessment (13.5%) and existing problems (12.7%). Based on these and information from official website, the process of doctor training could be divided into three stages: residency training, specialist training and continuing medical education, with the characteristics of critical standards and strict examination in each stage. Training programs for neurosurgeon and family practitioner were analyzed. Conclusions Medical specialists training is a systematic project, which needs comprechensive planning and taking all factors (such as requirement of medical care market, diseaseburden) into account . To establishing a connterpart in China, priority should be given to training quality, feasibility and improvability. At the same time, we should change our mind, face the reality, and deal with problems during the interim.
There is an increase in published studies relevant to the development of patient version of guidelines (PVGs). We reviewed, summarised and analysed the current developments in this field, with the aim of informing domestic scholars of the factors to consider when developing quality PVGs. We proposed three recommendations: (1) the concept of patient guidelines needs to be better defined; (2) a platform for the dissemination of PVGs should be established to support their implementation; and (3) a standardised PVGs development methodology should be developed to ensure the quality of the PVGs.
Objective To establish a cooperative decision-making model of county-level public hospitals, so as to freely select the best partner in different decision-making units and promote the optimal allocation of medical resources. Methods The input and output data of 10 adjacent county-level public hospitals in Henan province from 2017 to 2019 was selected. Based on the traditional data envelopment analysis (DEA) model, a generalized fuzzy DEA cooperative decision-making model with better applicability to fuzzy indicators and optional decision-making units was constructed. By inputting index information such as total number of employees, number of beds, annual outpatient and emergency volume, number of discharged patients, total income and hospital grade evaluation, the cooperation efficiency intervals of different hospitals were calculated to scientifically select the best partner in different decision-making units.Results After substituting the data of 10 county-level public hospitals in H1-H10 into the model, taking H2 hospital as an example to make cooperative decision, among the four hospitals in H1, H2, H7 and H10 of the same scale, under optimistic circumstances, the best partner of H2 hospital was H7 hospital, and the cooperation efficiency value was 1.97; in a pessimistic situation, the best partner of H2 hospital was H10 hospital, and the cooperation efficiency value was 0.98. The model had good applicability in the cooperative decision-making of county-level public hospitals. Conclusion The generalized fuzzy DEA model can better evaluate the cooperative decision-making analysis between county-level public hospitals.
ObjectiveTo evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes, quality of life and postoperative complications of breast cancer patients. MethodsA total of 100 breast cancer patients were included in this study through a prospective randomized controlled design, and were randomly divided into control group and intervention group, with 50 patients in each group. The control group received traditional treatment mode, while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making. The results of treatment, quality of life and postoperative complication rate were compared between the two groups. ResultsThe completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%, which was higher than that in the control group (80.0%), and the difference was statistically significant (P=0.037). The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%, which was higher than that in the control group (60.0%), with statistical significance (P<0.001). There was no significant difference in grade Ⅲ/Ⅳ toxicity between the two groups (P>0.05). After treatment, the scores of patients’ quality of life in the intervention group were higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the intervention group was 6.0%, which was lower than that in the control group (22.0%), and the difference was statistically (P=0.021). ConclusionsThe application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life, and effectively reduced the rate of postoperative complications. This model provides a new approach to the treatment of breast cancer that is more personalized, comprehensive and efficient.
Patients with severe traumatic brain injury (TBI) have a higher mortality rate, often dying within a few hours after injury. The management of trauma site, transportation, and early hospital stay is closely related to the outcome of TBI patients. The final success rate of TBI patients varies after different prehospital treatments, and the quality of prehospital treatment for TBI needs to be further improved. Therefore, the TBI prehospital management guideline emerged, and the third version of the guideline was released in April 2023. In order to provide better advice and guidance on the treatment of prehospital TBI, this article interprets the key points of updating the third edition of the prehospital TBI management guideline.
Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.
ObjectiveTo systematically review the influencing factors of breast cancer patients in treatment decision-making. MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, JBI Evidence Synthesis, CINAHL, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect qualitative studies about the influencing factors of breast cancer patients in treatment decision-making from inception to October 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then, the results were combined using integrating methods. ResultsA total of 13 studies were included. Sixty-seven results were extracted, with 22 results retained after incorporation and removal of duplications. The 22 results were grouped according to their similarities to form 6 categories. These categories resulted in two synthesized findings: influencing factors of patient participation in treatment decision-making and integration results and influencing factors of patients' treatment options. ConclusionBreast cancer patient participation in treatment decisions is influenced not only by internal factors, but also by family and external situational factors. When patients choose treatment, they consider not only their personal values and preferences, but also the impact of treatment on their families and their expectations. The choice is also influenced by social and cultural aspects.
