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.
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.
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.
ObjectiveTo explore the application effect of preoperative health education in patients with glaucoma. MethodsA total of 120 patients with glaucoma who underwent the surgery from February 2013 to December 2014 were randomly divided into control group and observation group, with 60 cases in each. The routine health education was performed on the patients in the control group while the personalized health education (on the basis of adopting the knowledge of the self-designed questionnaire) on the ones in the observation group. The results of Self-rating Anxiety Scale (SAS), Self-rating Depressive Scale (SDS), extent of disease knowledge, and nursing satisfaction were observed. ResultsAfter health education, the scores of SAS and SDS was 29.9±7.6 and 32.0±7.8, respectively in the observation group, which were significantly lower than those in the control group (34.9±7.9 and 35.9±8.3, P<0.05). Awareness of related knowledge and nursing satisfaction were 53 patients (88.3%) and 57 patients (95.0%) in observation group and 49 patients (81.7%) and 53 patients (88.3%) in the control group, (P>0.05). ConclusionPreoperative health education can improve the patients psychology and may reduce the occurrence of complications.
Objective We aimed to evaluate the comparative efficacy and cost-effectiveness of the ECMO versus mechanical ventilation through a rapid health technology assessment. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs), systematic reviews, meta-analyses, complete economic evaluations, and CRD database for HTA reports from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Descriptive analysis and summary were then performed. Results A total of 21 references were involved, including 2 HTA reports, 5 RCTs, 11 systematic reviews or meta-analyses, and 3 economic evaluations. The quality of the literature evidence was heterogenous, and only 2 RCTs of high quality were included for meta-analysis. The results showed that the difference of 60-day mortality between ECMO and mechanical ventilation was statistically significant (RR=0.73, 95%CI 0.57 to 0.92, P=0.007). The majority of recent meta-analysis literature showed that short-term mortality of ECMO treatment was lower than that of mechanically ventilated patients. The cost-effective literature from different countries all showed that it was cost-effective in their respective health system, however, the quality of the literature varied. Conclusions Current evidence shows that ECMO has better safety, effectiveness and cost-effectiveness for ARDS compared with mechanical ventilation. However, it still required to be verified by high-quality studies with a long-term follow-up. Validate conclusions are needed through rigorous health technology assessments.
Abstract Objective To investigate the disease constitution and hospitalization expenses in Songqiao Central Township Health Center (SqC) in Gaoyou City of Jiangsu Province in 2010, so as to provide the baseline data of disease burden for further study. Methods The inpatient records of SqC in 2010 were collected. The first discharge diagnoses were classified according to the International Classification of Disease 10 (ICD-10). The general information of the inpatients, discharge diagnosis, hospitalization expenses, disease category, age, gender, and reimbursement of expenses were described and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total number of inpatients was 1036 in 2010, and the gender ratio was about 1.0 (50.7% vs. 49.3%); b) The disease spectrum included 17 categories. The cumulative percents of the top 5 systematic diseases were 81.2%, including the respiratory, digestive, neoplasm, circulatory diseases, and injury, poisoning amp; external causes; c) The top 15 diseases were pneumonia, fracture, malignant neoplasm, benign neoplasm, acute bronchitis, cerebral infarction, hypertension, acute appendicitis, emphysema, cholecystolithias accompanied with cholecystitis, inguinal hernia, coronary heart disease, diabetes mellitus, chronic bronchitis and superficial injury; d) The patients suffering from pneumonia and acute bronchitis were mainly over 65 years old and younger than 5; e) The number of chronic diseases significantly increased with age, especially after the age of 35 years old, and reached the peak at the age over 65 years old; while the acute diseases were mainly distributed at the age younger than 15 yeas old and older than 65 years old. The average length of stay, the total hospitalization and out-of-pocket expenses per capita of the chronic diseases were more than those of the acute ones (13.8 days vs. 9.9 days, ? 3 082 vs. ? 2 615; ? 417 vs. ? 371, respectively); f)The length of stay and total hospitalization per capita were quite higher than the other township health centers (11.6 days vs. 5.2 days, ? 3 001.4 vs. ? 1 004.6); and g) Both of the total reimbursement and out-of-pocket expenses per capita accounted for 44%-57% of the total hospitalization expenses. Among the total reimbursement, the payment from New Cooperative Medical Scheme (NCMS) accounted for over 99%, while that from Medical Aid Scheme only accounted for less than 2%. Conclusion a) The top 3 systematic diseases of SqC are seen in respiratory system, digestive system and neoplasm. The acute diseases are mainly pneumonia and fracture; b) The number of acute or chronic diseases increases significantly with age, especially after 35 years old. Both adolescents and the aged suffer from the heaviest burden of diseases; c) The average length of stay and hospitalization expenses pre capita of SqC are much higher than those of the other township health centers; and d) NCMS is the major source of reimbursement. However, the proportion of out-of-pocket expenses and the burden of diseases are still very high and heavy. Thus the policy of NCMS needs to be adjusted step by step in future.
The Day Surgery Center of West China Tianfu Hospital of Sichuan University began operation in 2022, with a focus on same-day surgery. To ensure the quality of medical care for patients undergoing same-day surgery, the Day Surgery Center of West China Tianfu Hospital of Sichuan University utilizes information technology support and adopts an innovative patient health education model. This article mainly introduces the whole process management of health education for patients undergoing same-day surgery mentioned above, which involves many links before admission, during hospitalization, and after discharge. The aim is to provide reference for further optimization of same-day surgery and improve the quality and effectiveness of health education for patients undergoing same-day surgery.
【Abstract】ObjectiveTo compare the reliability of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and APACHE Ⅲ to estimate mortality of critical patients in abdominal surgery. MethodsTwo hundred and sixtyone critical patients in abdominal surgery were included in this study. The clinical data of the first day in ICU were collected and evaluated with both APACHE Ⅱand APACHE Ⅲ prognostic systems and statistical analysis were performed. Probability of survival (Ps) was compared with actual mortality. ResultsThe scores of APACHE Ⅱ and APACHE Ⅲ of death group were significantly higher than those of survival group respectively (P＜0.01). The actual mortality of patients whose Ps was no more than 0.5 was higher than that whose Ps was over 0.5 (P＜0.01). With two prognostic systems, the scores and mortality were the highest in pancreatitis patients and the lowest in patients with gastrointestinal malignant tumor. ConclusionAPACHE Ⅱ and APACHE Ⅲ prognostic systems can be effectively applied to the estimation of mortality of critical patients in abdominal surgery. For certain diagnostic categories, APACHE Ⅲ is better than APACHE Ⅱprognostic system.
Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.