Onehealth, an evidence-based decision-making software, is based on the United Nations' epidemiological reference modules to predict the effect of health services. Onehealth is a large database. The software is using activitybased costing, simulating investment costs of health system and changes of mortality in different coverage levels. By the cost of inputs/avoid deaths, it could quantify the cost of health services effectiveness and provide an intuitive basis for the rational allocation of health resources. This study introduces the relevant concepts, model structures and applications of Onehealth. We took the study of child nutrition interventions in Sudan for example and to present Onehealth tool's operating. As a new auxiliary and evidence-based decision-making software with scientific and rigorous theoretical approach, Onehealth has practical significance on the national or regional macro decision-making.
ObjectiveTo investigate the psychological status and its influencing factors of hospital staff during the outbreak of coronavirus disease 2019 (COVID-19), and provide a reference for psychological intervention strategies for hospital staff in public health emergencies.MethodsIn this cross-sectional study, we investigated the staff of Mianzhu People’s Hospital through an anonymous questionnaire survey sent through WeChat group from February 13th to 18th, 2020, to analyze the psychological situation and influencing factors of the on-the-job staff. SPSS 22.0 software was used for statistical analysis.ResultsAmong the 1 115 staff members who met the inclusion criteria, 951 completed the questionnaire, with a response rate of 85.3%. There were 945 valid questionnaires, with an effective response rate of 84.8%. A total of 224 staff members (23.7%) had mental health problems. Multivariate logistic regression analysis showed that the total scores of social support [odds ratio (OR)=0.869, 95% confidence interval (CI) (0.805, 0.938), P<0.001] and the total scores of stress coping strategies [OR=0.685, 95%CI (0.607, 0.772), P<0.001] were protective factors of psychological status, while having kids [OR=1.607, 95%CI (1.084, 2.382), P=0.018] and the position being logistic worker [OR=2.229, 95%CI (1.326, 3.746), P=0.002] were risk factors of psychological status.ConclusionsDuring the outbreak of COVID-19, mental health problems emerged among the staff of designated medical treatment hospital. When a public health emergency occurs, hospitals and relevant departments should take psychological intervention measures as soon as possible to ensure the work of epidemic prevention and control.
Objective To evaluate and select essential medicine for children with fever and adult gastrointestinal flu caused by common cold using evidence-based approaches based on the burden of disease for township health centers located in eastern, central and western regions of China. 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) 12 guidelines were included, 11 of which were evidence-based or based on expert consensus. We offered a recommendation for medicines used in the treatment including analgesics and antipyretics, decongestants, antihistamines, cough-relieving drug, phlegm-removing drug and drug for gastrointestinal symptoms. (2) A result of four RCTs (very low quality) indicated that in the treatment of children with cold, ibuprofen suspension had an antipyretic effect similar to paracetamol solution (for oral use) with a pooled result of 6-hour efficiency in relieving fever (RR 1.48, 95%CI 0.66 to 3.30, P=0.34). The major adverse effects of ibuprofen suspension included gastrointestinal reaction and profuse sweats (RR=1.23, 95%CI 0.72 to 2.11, P=0.45). With good applicability, ibuprofen suspension (for oral use with no need to be supervised) cost 1.93 yuan daily. (3) A result of three RCTs (low quality) indicated that after given for 30 minutes and one hour, paracetamol solution (suppository) was fairly superior to ibuprofen suspension in lowering the high temperature caused by fever (given for 30 min: MD= –0.16°C, 95%CI –0.21 to –0.11, Plt;0.01; given for one hour: MD= –0.19°C, 95%CI –0.28 to 0.10, Plt;0.01). As to adverse reaction, paracetamol solution (suppository) mainly included anal irritation, skin rashes and profuse sweats, which had a comparative result of incidence with ibuprofen suspension (RR=1.84, 95%CI 0.62 to 5.44, P=0.27). For children with fever, paracetamol solution (suppository) cost 0.90 yuan daily. With good applicability, paracetamol solution (suppository) was administered via the anus. Conclusion (1) We offer a b recommendation for ibuprofen suspension (2 g/100 mL) or acetaminophen (0.1 g/suppository) as symptomatic treatment used in children with fever, pain and discomfort caused by common cold, and for Huo Xiang Zheng Qi Jiao Nang (0.3 g/ capsule) used in adults with gastrointestinal flu. We also offer a weak recommendation for acetylcysteine (injection, 300 mg/mL, 10 mL/ampoule) used in patients with paracetamol poisoning. (2) In order to produce high-quality local evidence, we proposed that large-scale, well-designed, high-quality clinical and pharmacoeconomic studies on ibuprofen suspension and acetaminophen suppository in the treatment of children with fever, pain and discomfort caused by common cold should be further carried out. Besides, we proposed that large-scale, well-designed, high-quality clinical and pharmacoeconomic studies on Chinese patent drugs of Huo Xiang Zheng Qi used in chidren and Huo Xiang Zheng Qi Jiao Nang used in adults should further carried out. Moreover, we suggest that epidemiological investigation as well as clinical and pharmacoeconomic studies of acetylcysteine injection for paracetamol poisoning should be carried out and the instructions of acetylcysteine injection should be added in the guidelines of essential medicine in China. Finally, further studies on evidence of oxymetazoline, dextromethorphan and other Chinese patent drugs with the effect of relieving cough and treating cold should be carried out.
ObjectiveTo systematically review the detection rate of sub-health status of Chinese college students. MethodsThe CNKI, WanFang Data, CBM, VIP, PubMed, EMbase and Web of Science databases were searched to collect cross-sectional studies on the detection rate of sub-health among Chinese college students from inception to February 1, 2023. Two researchers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata 17.0 software. At the same time, GIS technology was used to analyze the spatial distribution of the detection rate of sub-health status of college students in China. ResultsA total of 44 articles were included, with a total sample size of 63 435 cases, including 29 255 cases of sub-health status. The results of meta-analysis showed that the detection rate of sub-health status of Chinese college students was 51.2% (95%CI 44.1 to 58.4). The temporal distribution showed a gradual decrease in the detection rate of sub-health states among college students between 2016 and 2020, with a rebound after 2020. The detection rates of sub-health states among college students in different regions and survey instruments varied significantly, with 74.1%, 61.8%, 58.4%, 56.1%, 47.0%, 42.3% and 21.6% in Southwest, Northeast, South, North, Central, East and Northwest China, respectively. The detection rates of sub-health states among college students in Jilin, Sichuan and Hebei provinces were the top 3, and Shanxi province had the lowest detection rate. ConclusionThe detection rate of university sub-health status in China is high, and the detection rate decreased significantly from 2016 to 2020, with a rebound trend in recent years, and there are differences in the detection rate of university sub-health status in different regions and survey instruments. Due to the limitation of the quality and quantity of the included studies, the above findings need to be verified by more high-quality literature.
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
ObjectivesTo evaluate the reporting quality of clinical practice guidelines published in Chinese journals in 2017.MethodsCBM, CNKI and WanFang Data databases were searched for articles published in 2017. Two reviewers independently screened literature, extracted data, and evaluated the reporting quality of clinical practice guidelines using the Reporting Items for Practice Guidelines in Healthcare (RIGHT).ResultsOne hundred and seven clinical practice guidelines were included and a total reporting rate of 34.8%±0.1% in RIGHT. Among the seven domains of RIGHT, field on basic information had the highest reporting rate (56.8%) and fields on review and quality assurance had the lowest reporting rate (9.3%).The average reporting rate of RIGHT items of Chinese Science Citation Database (CSCD) articles was lower than non-CSCD [MD=−0.73, 95%CI (−0.78, −0.68)] articles. The average reporting rates of RIGHT items differed between Chinese Medical Association (CMA) journal articles and non-CMA journal articles [MD=2.30, 95%CI (2.26, 2.34)]. The average reporting rates of RIGHT items was lower in guidelines established by associations or institutes [MD=−3.78, 95%CI (−3.83, −3.73)], and was higher reported in Chinese medicine guidelines [MD=21.94, 95%CI (21.91, 21.97)].ConclusionsThe reporting quality of clinical practice guidelines published in journals of mainland China in 2017 is low in general, especially in fields such as review and quality assurance, funding and declaration and management of interests and other information. To improve this phenomena, it is suggested that guideline developers report the guidelines rigorously with international standard.
Objective To analyze the application of lean healthcare management in optimizing services in foreign operating rooms, and provide a theoretical reference for further optimizing service processes in domestic operating rooms with lean healthcare management. Methods PubMed and Web of Science databases were searched literature about lean healthcare management in optimizing foreign hospital operating room service process. The search period was from the establishment of databases to November 2024. The number of publications, publishing institutions, authors, citation frequencies, keywords, the use of lean management tools and the improvement status were analyzed.Results A total of 71 literatures were included. Among them, 17 literatures were published from 2008 to 2014, and the number of related literatures increased significantly since 2015, with 54 literatures published by 2024; 9 literatures were published by universities and 62 literatures were published by hospitals. In terms of the distribution of countries and regions where the literatures were published, there were 34 literatures from the United States, 12 from the United Kingdom, 5 from Italy, 4 from Switzerland, and 3 from Canada. The keywords basically presented the combination ofthemes related to operating room management and lean healthcare management improvement fields, such as lean six sigma, quality improvement, and operating room efficiency. The five lean tools with the highest frequency of occurrence in the 71 included literatures were value stream mapping, fishbone diagram, A3 report, PDCA cycle management, and 5S. Conclusions There is an imbalance in the development of lean healthcare management research, with the number of publications in developed countries being far higher than that in developing countries. Lean healthcare management is conducive to improving surgical safety, work efficiency, and patient-doctor satisfaction. Lean healthcare management should further adapt to the actual situation, unify the lean management indicators in operating rooms, conduct cross-departmental cooperation, maximize the effectiveness of lean improvement tools, and achieve modern medical management.
Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.
The traditional Chinese medicine has played an important role in the prevention and control of coronavirus disease 2019 (COVID-19). Based on the role of traditional Chinese medicine in dealing with the previous epidemics and COVID-19, this paper analyzes the problems and challenges of current situation, and focuses on improving traditional Chinese medicine scientific identification, strengthening the construction of traditional Chinese medicine system, and increasing the intensity of Chinese and Western medicine and so on. In order to improve the cooperation mechanism of Chinese and Western medicine for epidemic prevention and control, and give full play to the role of traditional Chinese medicine in the construction of national public health emergency system, this paper also gives ten corresponding suggestions.
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.