Objective To establish standards, methods and processes for evidence-based evaluation and selection of essential medicine that meet the needs of the 8 pilot township health centers in China. Methods A descriptive analysis was conducted to compare the similarities/differences and the advantages/disadvantages of the standards, methods and processes between the World Health Organization (WHO) essential medicines evaluation and selection, and the GRADE evidence quality and recommend intensity. In combination with the former outcomes of this series of study, the standards, methods and processes of evidence-based evaluation and selection of essential medicines in the domestic pilot township health centers were optimized, restructured and improved. Softwares such as GRADEprofiler were used to assess the quality of evidence. Results a) Localized standards, methods and processes for evidence-based evaluation and selection of essential medicine were established, and the evaluation tool was ascertained; and b) Disease and drug names, guidelines and searching processes for evaluation and selection of essential medicine were developed with standardized, systematic and transparent approaches. Conclusion a) Standards, methods and processes for searching, evaluating and recommending the best evidence are preliminarily established, through comparative analysis on the effectiveness, safety, cost-effectiveness and applicability of the candidate medicines for diagnosing, treating and preventing diseases in township health centers in China; b) Following the principle of “utilizing the best existing evidences and developing the urgently-needed but lacking evidence”, a good exploration was done for the localization, standardization and transparency of the standards, methods and processes of evidence-based evaluation and selection of essential medicine for pilot township health centers.
This article briefly introduces the status and problems of research and application on medical professionalism in China; proposes the concept of translational medicine and the challenges of introduction of translational medicine to physician professionalism research and translation. Some measurements or approaches to promote research translation on medical professionalisms are proposed to shorten the distance from research outcomes to practical application, in order to carry out evidence-based construction of modern medical professionalism of Chinese characteristics and build a harmonious doctor-patient relationship.
Objective To evaluate the performance of emergency medical rescue (EMR) within 1 month after Lushan earthquake, and to prove and enrich the experience from Wenchuan earthquake, so as to provide useful references for global earthquake EMR with regard to decreasing death and disability rates. Methods All the following date published within 1 month after 4.20 Lushan earthquake were collected and analyzed, including official information, public documents, news release, relevant information from websites and victims’ medical records in the West China Hospital, then the relevant domestic and foreign literature about EMR (including EMR of Wenchuan earthquake). And then comparative analysis was conducted to evaluate the performance of EMR in Lushan earthquake. Results a) Being 87 km apart from each other, the main seismic zones of Lushan and Wenchuan located in the south west and middle north of Longmenshan fault zone, respectively. Although only 1 earthquake magnitude differed between them, the disaster area, and the number of affected population, deaths, disappearances, injured, severe injured and migration population in Wenchuan earthquake were 40, 23, 353, 853, 27, 14 and 51 times higher than those in Lushan earthquake, respectively. b) Learned from Wenchuan experience, the manpower scheduling in Lushan earthquake was quicker: the assembled medical personnel peak of Lushan vs. Wenchuan was 87.62% vs. 56.06 % in golden 72 hours post-quake. c) Supplies scheduling was more rational: the utilization rate was higher under the guidance of accurate information of demand. d) Medical treatment was more rational and efficient: the critical injured were treated following “Four concentration treatment principles”; saving life and restoring function at the same time; treatment and physical-mental rehabilitation at the same time; treatment and evidence production and implementation at the same time. e) Medical institutions and service returned to normal in time: 96.7% (440/455) of government owned township medical institutions in 21 affected towns returned to normal and provided medical services at their original sites. Conclusion By learning form Wenchuan experience, the following performance is implemented in Lushan earthquake: medical rescue guided by the accurate information; supplies scheduling guided by the accurate demand; both critical injured treatment,and physical-mental rehabilitation guided by the accurate assessment of injuries. So the medical rescue within 1 month after Lushan earthquake is quicker, more rational and efficient. After 20 days post quake zero death of critical injured was achieved. The early physical-mental rehabilitation fastens the functional reconstruction of the injured and helps them return to the society. So it suggests that the Lushan EMR enriches and develops the reference value of EMR experience of Wenchuan earthquake.
Objective To evaluate and select essential medicine for middle-aged and elderly women with primary osteoporosis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) 18 guidelines were included, 14 of which were evidence-based or based on expert consensus. Recommended medicines included bisphosphonates, calcitonin, estrogen, parathyroid hormone, selective estrogen receptor modulator, strontium and Chinese patent drug. (2) A result of one quasi-RCT (very low quality) indicated that caltrate D had a better effect on elderly women with primary osteoporosis than calcium gluconate in improving bone mineral density (BMD) (MD=0.04, 95%CI 0.02 to 0.06) and ameliorating bone ache ( RR=2.64, 95%CI 1.40 to 4.96). A few cases treated by caltrate D presented with adverse reaction such as gastrointestinal discomfort, poor appetite, constipation and nausea which disappeared later. Caltrate D (calcium carbonate D3) with good applicability cost 1.00 yuan daily. (3) A result of one RCT (low quality) indicated that alendronate had a better effect than caltrate D in improving L2-L4 BMD (MD=0.06, 95%CI 0.017 to 0.10) and ameliorating bone ache (RR=1.8, 95%CI 1.40 to 2.52). A result of two RCTs (moderate quality) indicated that alendronate plus calcium carbonate plus vitamin D6 had a better effect than calcium carbonate plus vitamin D in improving L2-L4 BMD (MD=0.05, 95%CI 0.02 to 0.08) and reducing blood alkaline phosphatase (MD=–31.9, 95%CI –54.99 to –8.81). There were slight adverse effects mainly including gastrointestinal reaction. Alendronate with fairly poor applicability cost 2.67 yuan daily. (4) A result of one RCT (moderate quality) indicated that after a 3-month treatment, Xian Ling Gu Bao Jiao Nang (name of a Chinese patent drug, abbreviated as XLGB) plus calcium preparation had a better effect than calcium preparation alone (MD=10, 95%CI 0.05 to 0.15). A result of one RCT (moderate quality) indicated that given for 3 to 6 months, XLGB plus calcium preparation was superior to calcium preparation alone in increasing the density of Ward’s triangle and the great femoral trochanter. A result of one RCT (low quality) indicated that XLGB plus calcitriol had a better effect than calcitriol alone in pain relief (RR=1.26, 95%CI 1.04 to 1.52). There were slight adverse effects mainly including reaction in the digestive system, the circulatory system and the skin. XLGB with good applicability cost 4.58 yuan daily. Conclusion We offer a weak recommendation for alendronate applied to middle-aged and elderly women with primary osteoporosis and pain and fracture caused by primary osteoporosis. We also offer a b recommendation for caltrate D and XLGB applied to middle-aged and elderly women with primary osteoporosis and pain and fracture caused by primary osteoporosis. In addition, we propose that the census on elder people with osteoporosis in rural areas should be carried out. More clinical and pharmacoeconomic studies of large-sample, high-quality on alendronate and its calcium preparation for adult osteoporosis are needed in China.
The outbreak of pneumonia caused by novel coronavirus (COVID-19) at the end of 2019 was a major public health emergency in human history. In a short period of time, Chinese medical workers have experienced the gradual understanding, evidence accumulation and clinical practice of the unknown virus. So far, National Health Commission of the People’s Republic of China has issued seven trial versions of the “Guidelines for the Diagnosis and Treatment of COVID-19”. However, it is difficult for clinicians and laymen to quickly and accurately distinguish the similarities and differences among the different versions and locate the key points of the new version. This paper reports a computer-aided intelligent analysis method based on machine learning, which can automatically analyze the similarities and differences of different treatment plans, present the focus of the new version to doctors, reduce the difficulty in interpreting the “diagnosis and treatment plan” for the professional, and help the general public better understand the professional knowledge of medicine. Experimental results show that this method can achieve the topic prediction and matching of the new version of the program text through unsupervised learning of the previous versions of the program topic with an accuracy of 100%. It enables the computer interpretation of “diagnosis and treatment plan” automatically and intelligently.
Objective To provide a reference for the exploration to the characteristic specialized subjects in well-off township hospital construction principle, thought and standard through investigating the basic medical units in Shuangliu County. Methods Self-designed questionnaires were made to survey the current situation of characteristic professional subjects in 24 county township medical units comprehensively (i.e. 3 central township hospitals, 3 community health centers, and 18 general township hospitals). Epidate 3.1 was used for data input, SPSS 17.0 was used for descriptive statistics and stratified analysis. Results Fifteen among 24 township hospitals in Shuangliu County set up 21 characteristic specialized subjects, accounted for 62.5%; Traditional Chinese Medicine Orthopedics Subjects were set up in 9 hospitals, accounted for 42.9% ranked as the top; Chinese Medicine Rehabilitation Physiotherapy Subjects were set up in 6 hospitals, accounted for 28.6% ranked as the second. Conclusion The characteristic specialized subjects in township hospitals should be established with reasonable planning and construction according to diagnosis and therapy demand for local disease and hospital’s condition, so as to promote characteristic medical services in market competition by subject construction. Traditional Chinese Medicine Orthopedics Subject and Chinese Medicine Rehabilitation Physiotherapy Subject are worth to be established and spread as characteristic specialized subject.
Objective To survey the present situation of medical equipment configuration of township hospitals in Shuangliu County, to provide baseline data for the next step of discussing the well-off township hospital medical equipment configuration standards. Methods According to the national guidance on device configuration in township hospitals, the questionnaire was made to survey 24 county township medical units (i.e. 3 central township hospitals, 3 community health centers, and 18 general township hospitals). The descriptive and stratified analysis was performed for the survey results. Results The condition of medical equipment configuration in the 3 central hospitals was better than that in the 3 community health centers which was better than that in the 18 general hospitals. The emergency equipment configuration such as defibrillator units, breathing airbags, and tracheotomy package was poor. Annual inspection rate of medical metering equipment was lower than expectation. In 2010, a total of 127 medical measuring equipments from 98.5% of the township hospitals applied annual inspection, among which, only the total annual rate of black and white B ultrasonic and X-ray machine reached above 60%; the rate of blood cells analyzer, ECG monitoring instrument, and biochemical analyzer were between 50% to 60%; and the rate of urine analyzer was the lowest at 4.5%. Conclusion It is the right time to strengthen the first aid equipment configuration in township hospitals and to enhance the annual inspection rate of the medical measuring equipment, so that the safety use and accuracy detecting can be guaranteed.
Objective To investigate the disease constitution of Yaqian Township Health Center (YQT) in Xiaoshan District of Zhejiang Province from 2008 to 2010, so as to provide baseline data for further study. Methods Questionnaire and focus interview were carried out to collect inpatients’ case records from 2008 to 2010. The first diagnoses were classified according to ICD-10, and the data of discharge diagnoses were rearranged and analyzed by using Excel 2003 and SPSS 13.0 software. Results a) The total numbers of inpatients were 182, 195 and 248 from 2008 to 2010, respectively; b) The disease spectrum included 9-14 categories, which accounted for 47.6%-66.7% of ICD-10; c) The top 6 systematic diseases accounted for 37.37%-75.39%, which included the circulatory, injury, digestive, respiratory, neoplasms and urinary and reproductive systematic diseases; d) A total of 8 of the top 15 single diseases were the same, including hypertension, great saphenous vein varices, redundant prepuce, lung cancer, fracture, superficial injuries, acute appendicitis, and inguinal hernia; and e) The constitution ratio of the chronic diseases, compared with the acute ones, was higher in 2008, but lower in 2009 and 2010. Conclusion a) In recent three years, the main systematic diseases seen in YQT have been circulatory, injury, digestive, respiratory, neoplasms, and urinary and reproductive systematic diseases. The newly increased diseases in 2010 were pregnancy, childbirth and puerperium. The acute diseases mainly are fracture and injure, while the chronic diseases mostly are hypertension; b) A total of 8 of the top 15 single diseases are the same, indicating the stability of the common inpatients’ diseases; and c) Attention should be paid in future to the chronic diseases management, women’s health and specialized subject construction.