Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of ...Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.MannWhitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P<0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0to 4.0)],percentage of medicines prescribed by generic[50.4%(IQR:47.4%to 65.0%)],percentage of encounters with antibiotic prescribed[40.2%(IQR:30.5%to 52.7%)],percentage of encounters with injection prescribed[18%(IQR:3.2%to 30.0%)]and the percentage of medicines prescribed from essential medicines list[82.0%(IQR:66.4%to 89.3%)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pandemic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.展开更多
The socio-ecological environmental problem caused by the development of coalbed methane(CBM)is becoming more serious,so it is very significant for accelerating the development of CBM industrialization to identify the ...The socio-ecological environmental problem caused by the development of coalbed methane(CBM)is becoming more serious,so it is very significant for accelerating the development of CBM industrialization to identify the main influential factors of socioecological environmental risks and take effective risk prevention measures.Based on the triangular fuzzy number method,this paper firstly establishes a comprehensive correlation matrix.Then,the affected factors of socio-ecological environmental risks are analyzed by the DEMATEL method during the development of CBM.Then according to the aspects of centrality and causality,the key indicators are determined.Furthermore,the scenario simulation based on the FCM,the steady-state value and the comprehensive importance of key indicators,and the core indicators are selected.Finally,the scenario simulation of risk management countermeasure is done.The results show that:①The index weights are calculated by the triangular fuzzy numbers,and the correlation matrix in DEMATEL is obtained by the weight ratio,which reduces the shortcomings and the subjectivity of traditional DEMATEL method.②The correlation matrix in FCM is established based on the comprehensive correlation matrix in the above improved DEMATEL,which not only makes the FCM model more comprehensive and reduces the difficulty that the FCM correlation matrix is obtained considering the indirect influence relationship between indicators,but also makes up for the disadvantages that DEMATEL excludes during the selection of the core indexes,which are the considerations of the dynamic change of the importance of the indicators.③The rate of forestry and grass coverage,the ratio of investment in prevention and construction,the pollution index of soil Merlot,the reliability of machinery and equipment,the standard evaluation index of major pollution factors of underground water,and the ability of personal risk prevention are the key indicators,in which the rate of forestry and grass coverage,the ratio of investment in prevention and construction,and the reliability of machinery and equipment are the core indicators and are extremely important for the management of socio-ecological environmental risks during the development of coalbed methane.④The results of the scenario simulation of risk management countermeasure show that the core variables affect the socio-ecological environmental risks through such indicators as the degree of production mechanization,the degree of demolition and resettlement,and the ratio of economic loss by the influenced mechanism analysis;the ratio of investment in prevention and construction has the greatest impact on the socio-ecological environment risks in the early stage of CMB development,while the rate of forestry and grass coverage is the most important in the middle and late stages by the influenced result analysis.Therefore,this paper puts forward some corresponding stage suggestions on the prevention and control of socio-ecological environmental risks during the CMB development.In the early stage of CMB development,the ratio of investment in prevention and construction should be increased.In the middle stage,it is very important to reduce the damage of vegetation regions and to improve the reliability of machinery and equipment;in the late stage,the investment in prevention and construction should be increased steadily and the recovery of damaged vegetation areas should be focused on.展开更多
文摘Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.MannWhitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P<0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0to 4.0)],percentage of medicines prescribed by generic[50.4%(IQR:47.4%to 65.0%)],percentage of encounters with antibiotic prescribed[40.2%(IQR:30.5%to 52.7%)],percentage of encounters with injection prescribed[18%(IQR:3.2%to 30.0%)]and the percentage of medicines prescribed from essential medicines list[82.0%(IQR:66.4%to 89.3%)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pandemic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.
文摘The socio-ecological environmental problem caused by the development of coalbed methane(CBM)is becoming more serious,so it is very significant for accelerating the development of CBM industrialization to identify the main influential factors of socioecological environmental risks and take effective risk prevention measures.Based on the triangular fuzzy number method,this paper firstly establishes a comprehensive correlation matrix.Then,the affected factors of socio-ecological environmental risks are analyzed by the DEMATEL method during the development of CBM.Then according to the aspects of centrality and causality,the key indicators are determined.Furthermore,the scenario simulation based on the FCM,the steady-state value and the comprehensive importance of key indicators,and the core indicators are selected.Finally,the scenario simulation of risk management countermeasure is done.The results show that:①The index weights are calculated by the triangular fuzzy numbers,and the correlation matrix in DEMATEL is obtained by the weight ratio,which reduces the shortcomings and the subjectivity of traditional DEMATEL method.②The correlation matrix in FCM is established based on the comprehensive correlation matrix in the above improved DEMATEL,which not only makes the FCM model more comprehensive and reduces the difficulty that the FCM correlation matrix is obtained considering the indirect influence relationship between indicators,but also makes up for the disadvantages that DEMATEL excludes during the selection of the core indexes,which are the considerations of the dynamic change of the importance of the indicators.③The rate of forestry and grass coverage,the ratio of investment in prevention and construction,the pollution index of soil Merlot,the reliability of machinery and equipment,the standard evaluation index of major pollution factors of underground water,and the ability of personal risk prevention are the key indicators,in which the rate of forestry and grass coverage,the ratio of investment in prevention and construction,and the reliability of machinery and equipment are the core indicators and are extremely important for the management of socio-ecological environmental risks during the development of coalbed methane.④The results of the scenario simulation of risk management countermeasure show that the core variables affect the socio-ecological environmental risks through such indicators as the degree of production mechanization,the degree of demolition and resettlement,and the ratio of economic loss by the influenced mechanism analysis;the ratio of investment in prevention and construction has the greatest impact on the socio-ecological environment risks in the early stage of CMB development,while the rate of forestry and grass coverage is the most important in the middle and late stages by the influenced result analysis.Therefore,this paper puts forward some corresponding stage suggestions on the prevention and control of socio-ecological environmental risks during the CMB development.In the early stage of CMB development,the ratio of investment in prevention and construction should be increased.In the middle stage,it is very important to reduce the damage of vegetation regions and to improve the reliability of machinery and equipment;in the late stage,the investment in prevention and construction should be increased steadily and the recovery of damaged vegetation areas should be focused on.
