Objective To explore the serious situation of injection abuse, and its influence to average prescription fee. Methods The subjects of this study were health service settings in rural area of 9 provinces/cities in Midwest of China. The treatment prescription indicators of county and village health service settings were calculated. Results Prescription injection rates of health care facility in rural area of Midwest provinces/cities of China (25.8% to 62.2%,mean: 45.1%) were higher than the standard of WHO (13.4% to 24.1%), and the injection abuse situation was serious. Injection bause caused the increase of prescription fee. Excess usage of injection in health service settings was related to the economic level of the on-site county or village, and also related to the size and load of health service facilities. Conclusion Suggestions are proposed to the government health agency according to the results of the study: enhancing the lawmaking, establishing the related policy and effective measure, training the medical personnel, promoting the mass health education, investigating the effective injection management model in rural area, and reducing the rate of injection.
Objective To broaden the current understanding of the usage willingness about artificial intelligence (AI) robots and relevant influence factors for elderly patients. Methods The elderly patients in the inpatient ward, outpatient department and physical examination of the Department of Geriatrics, West China Hospital of Sichuan University were selected by convenient sampling for investigation between February and April 2020, to explore the willingness of elderly patients to use AI robots and related influencing factors. Results A total of 446 elderly patients were included. There were 244 males and 202 females. The willingness to use AI robots was (14.40±3.62) points. There were statistically significant differences among the elderly patients with different ages, marital status, living conditions, educational level, current health status, current vision status, current hearing status, self-care ability and family support in their willingness to use AI robots (P<0.05). Multiple linear regression analysis showed that age, education level and family support were the influencing factors of use intention (P<0.05). Among the elderly patients, 60.76% had heard of AI robots, but only 28.03% knew the medical application of AI robots, and only 13.90% had used AI robot services. Most elderly patients (>60%) thought that some adverse factors may reduce their usage willingness, like “the price is too expensive” and “the use is complex, or I don’t know how to use”. Conclusions Elderly patients’ cognition of AI robots is still at a low level, and their willingness to use AI robots is mainly affected by age, education level and family support. It is suggested to consider the personalized needs of the elderly in terms of different ages, education levels and family support, and promote the cheap and user-friendly AI robots, so as to improve the use of AI robots by elderly patients.
ObjectiveTo investigate the development, production and use of children’s drugs in Sichuan Province, analyze the problems existing in these links, and provide suggestions for ensuring that children’s needs for drugs are met. MethodsThe self-filling electronic questionnaire was used to investigate the production, procurement and use of children’s drugs in 14 pharmaceutical companies producing children’s drugs and 20 general hospitals with pediatric departments or children’s hospitals in Sichuan province. ResultsThe 14 surveyed pharmaceutical companies reported that 116 children’s drugs were being developed or produced (75 first-class children’s drugs with exact medication information for children, 41 second-class children’s drugs only noted as children's discretionary reduction or use according to clinician’s instructions), out of which 109 (93.97%) drugs had been approved for marketing, 21 (18.10%) were national essential medicines and 76 (65.52%) were covered by national basic medical insurance. The dosage forms of first-class children's drugs were mainly tablets (28, 37.34%) and granules (19, 25.34%), while oral solution (3, 4.00%), syrup (5, 6.67%) and other dosage forms suitable for children were less. According to the surveyed results on the use of children's drugs in hospitals, there were 57 children’s drugs whose minimum use units needed to be manually divided into smaller ones on average in each hospital, and it was the most common operation pattern that pharmacists informed nurses, patients or patients’ family members of the dose splitting methods and then splitting drugs’ minimum use units by themselves. ConclusionThere is a great demand for splitting minimum use units of drugs whose strength is too big for children in medical institutions, and some children’s drugs need to be developed and further modified to meet the clinical children’s drug needs. We should further increase investments and policy supports for the children’s drugs, promote children’s clinical trials, and encourage the research and development of children’s drugs.
ObjectiveTo investigate the efficacy and safety of intravenous diltiazem in controlling ventricular rate in elderly patients with atrial fibrillation. MethodWe retrospectively analyzed the clinical data of patients suffering from atrial fibrillation with rapid ventricular rate presented to the Emergency Department between January 2014 and January 2015, and found that 57 elderly patients aged over 70 were treated with intravenous diltiazem for ventricular rate controlling. We analyzed the general situation of this group of patients, the changes of heart rate and mean arterial pressure before and after the treatment, and the adverse reactions to the treatment. ResultsThe total effective rate was 92.9%, and the mean onset time was (13.3±7.3) minutes. The mean arterial pressure showed no significant difference after treatment, and the heart function showed no significant deterioration. Only 4 patients (7.0%) had symptoms of transient hypotension. ConclusionsFor elderly patients with atrial fibrillation with rapid ventricular rate, intravenous diltiazem can control the ventricular rate rapidly, efficiently, safely, and sustainably.
ObjectiveTo investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
ObjectivesTo investigate Chinese health practitioners’ usage and demand for clinical practice guidelines in general so as to improve the development and implementation of guidelines.MethodsWe conducted a cross-sectional questionnaire survey that covered health practitioners from different levels of medical institutions in 17 provinces in China. Attitudes, adherence, usage barriers and demands for clinical practice guidelines were investigated.ResultsA total of 953 health practitioners were involved in the survey in which 931 completed the questionnaires. Respondents generally held positive attitudes toward guidelines and agreed that they improved quality of care and standardized diagnosis and treatment. More than 80% of the respondents reported a fine adherence to guidelines. The most reported barriers to follow the guidelines were " several guidelines are competing” and " lack of facilities and medical resources”. Most respondents agreed that it was necessary to establish a national guideline database, appraise implementation effect of guidelines, develop evaluation tools for guidelines that are applicable for Chinese clinical practice, and provide guidelines training.ConclusionsThis study finds favorable attitudes and fine adherence towards clinical guidelines in general in China. However, internal barriers, such as authority of guidelines, and external barriers, such as supplying system and patients’ preference, can affect guideline dissemination and implementation. It is suggested that establishing a national guidelines database, developing evaluation tools for guidelines that fit for Chinese clinical practice, and provision of guideline training, would facilitate the use of guidelines.
With the real-world study (RWS) becoming a hotspot for clinical research, health data collected from routine clinical practice have gained increasing attention worldwide, particularly the data related to the off-label use of drugs, which have been at the forefront of clinical research in recent years. The guidance from the National Medical Products Administration has proposed that real-world evidence (RWE) can be an important consideration in supporting label expansions where randomized controlled trials are unfeasible. Nevertheless, how to use the RWE to support the approval of new or expanded indications remains unclear. This study aims to explore the structured process for the use of RWE in supporting label expansions of approved drugs, and to discuss the key considerations in such process by reviewing the documents from relevant regulatory agencies and publications from public databases, which can inform future directions for studies in this area.
It has been 36 years since the first version of essential medicine list (EML) was released by WHO in 1977,when 18 versions of WHO-EML and four versions of children essential medicine list have been released. In 1982, the first version of national essential medicine list (NEML) was released in China. Till 2012, there were eight versions of NEML in total. This paper introduces WHO-EML in aspects of origin, idea, definition, design, and innovation of selection methodology,principle, and workflow; compares the evolution, design, selection methodology between WHO-EML and Chinese NEML; and points out the challenges of evaluation and decision making of Chinese NEML.
Objective To systematically review the willingness to use pre-exposure prophylaxis (PrEP) and its influencing factors among men who have sex with men (MSM) in China. Methods We conducted a comprehensive search on various databases, including China National Knowledge Infrastructure, VIP database, Wanfang data, China Biomedical Literature Service System, PubMed, Web of Science, Cochrane Library, and Embase, covering the period from database inception to September 6th, 2023. We focused on studies that publicly reported data on the willingness to use PrEP and its influencing factors among MSM in China. The quality of included studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. RevMan 5.3 software and Stata 13.1 software were used to perform meta-analysis for the willingness to use PrEP and its influencing factors among MSM in China. Results A total of 24 cross-sectional studies with 19 influencing factors and a sample size of 16499 participants were included in the review. The results revealed a PrEP usage intention rate of 60.4% [95% confidence interval (CI) (51.8%, 68.9%)] among the MSM population in China. Factors such as awareness of PrEP [odds ratio (OR)=5.26, 95%CI (1.33, 20.82)], having heard of PrEP [OR=1.84, 95%CI (1.28, 2.64)], age<25 years [OR=1.92, 95%CI (1.34, 2.77)], being a student [OR=1.92, 95%CI (1.17, 3.16)], monthly income of 1000-3000 yuan [OR=1.36, 95%CI (1.12, 1.65)], history of human immunodeficiency virus (HIV) testing [OR=2.05, 95%CI (1.53, 2.74)], history of sexually transmitted infections [OR=1.75, 95%CI (1.27, 2.40)], seeking sexual partners online [OR=1.38, 95%CI (1.19, 1.59)], openness about sexual orientation [OR=1.90, 95%CI (1.27, 2.84)], having a non-local household registration [OR=1.66, 95%CI (1.37, 2.02)], and recommending PrEP to friends [OR=20.14, 95%CI (2.59, 156.91)] were identified as promoting factors for the willingness to use PrEP. Conversely, a homosexual orientation [OR=0.67, 95%CI (0.52, 0.85)] was identified as a barrier to the willingness to use PrEP. Conclusions Chinese MSM have a low intention to use PrEP, and there are many factors affecting the intention to use PrEP in MSM. In the future HIV prevention and control work, measures such as strengthening education and publicity of PrEP, providing a certain degree of support for PrEP costs, strengthening health education on campus, strengthening community organizations and support networks should be taken to promote the willingness of MSM to use PrEP.