OBJECTIVE:To assess the long-term effectiveness of Huangqi(Radix Astragali Mongolici,HQ)-based Traditional Chinese Medicine(TCM)in the treatment of diabetic peripheral neuropathy(DPN).METHODS:Nine databases were searc...OBJECTIVE:To assess the long-term effectiveness of Huangqi(Radix Astragali Mongolici,HQ)-based Traditional Chinese Medicine(TCM)in the treatment of diabetic peripheral neuropathy(DPN).METHODS:Nine databases were searched to retrieve available randomized controlled trials that compared HQbased TCM and Western Medicines in the treatment of DPN.The methodological quality of the included studies was assessed using the Cochrane bias risk tool,and RevMan 5.4 was used for data analysis.The effect estimates of interest were risk ratio(RR),mean difference(MD)or standardized mean difference(SMD)with 95%confidence interval(CI).RESULTS:The results from 48 available studies assessing 3759 patients demonstrated that cases administered HQ-based TCM[RR=1.30,95%CI(1.21,1.40),P<0.00001]or HQ-based TCM combined with Western Medicines[RR=1.25,95%CI(1.19,1.31),P<0.00001]exhibited higher total efficacy rates than individuals who received Western Medicine alone.The results showed that the HQ-based TCM group had decreased Toronto Clinical Scoring System scores[MD=-1.50,95%CI(-1.83,-1.17),P<0.00001],and reduced serum interleukin 6[SMD=-0.57,95%CI(-0.87,-0.27),P=0.0002]and tumor necrosis factors-αlevels[SMD=-0.60,95%CI(-0.95,-0.25),P=0.0009].In addition,both HQ-based TCM and HQbased TCM combined with Western Medicine increased nerve conduction velocity and decreased glycaemia compared with Western Medicine alone.In terms of blood lipids,oxidative stress and adverse drug reactions,there were no significant differences between the HQ-based TCM groups and the Western Medicine control group.CONCLUSION:The current Meta-analysis revealed that HQ-based TCM yields higher efficacy and safety than Western Medicine alone for the treatment of DPN,although further well-designed RCTs are required to validate these findings.展开更多
Background： China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measur...Background： China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis （DEA） model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development. Methods： We chose 12 country-level hospitals based on geographical distribution and the economic development level inAnhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions. Results： During 2010-2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was 〉1, and the rest are 〈1 between 2010 and 2015. Conclusions： In 2010-2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.展开更多
Background： The self-consciousness and practicality of preferentially prescribed essential medicines （EMs） are not high enough in county hospitals. The purposes of this study were to use the information-motivation-...Background： The self-consciousness and practicality of preferentially prescribed essential medicines （EMs） are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills （IM B） model to identify the predictors of essential medicines prescribing behavior （EMPB） among doctors and to examine the association between demographic variables, IMB, and EMPB. Methods： A cross-sectional study was carried out to assess predictive relationships among demographic variables and IM B model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the I MB model to test the instruments using analysis of moment structures 17.0. Results： A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old （range： 22-67 years old）. The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 a： 7.34 （hundred mark system： 75.77） and 19.92 ± 3.44 （hundred mark system： 79.68）, respectively. Approximately half（50.8%） of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data （x^2/df= 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066）. More work experience （β = 0.153, P 〈 0.001 ） and behavioral skills （β = 0.449, P 〈 0.001 ） predicted more EMPB. Higher income predicted less information （β = -0.197, P 〈 0.001） and motivation （β =0.204, P 〈 0.001 ）. Behavioral skills were positively predicted by information （β = 0.135, P 〈 0.001 ） and motivation （β = 0.742, P 〈 0.001 ）. Conclusion： The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.展开更多
Patients undergoing major oncological surgery for head and neck cancer （SHNC） have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia （VAP） in ...Patients undergoing major oncological surgery for head and neck cancer （SHNC） have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia （VAP） in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6~0 （n = 95） in patients who required more than 48 h of mechanical ventilation. Staphylococcus （37.7%）, Enterobacteriaceae （32.1%）, Pseudomonas （20.8%）, and Haemophilus （16.9~） were the major bacterial species that caused VAP. The independent risk factors for VAP were advanced age, current smoking status, chronic obstructive pulmonary disease, and a higher simplified acute physiology score system II upon admission. Tracheostomy was an independent protective factor for VAP. The median length of stay in the ICU for patients who did or did not develop VAP was 8.0 and 6.5 days, respectively （P = 0.006）. Mortality among patients who did or did not develop VAP was 16.8% and 8.4%, respectively （P 〈 0.001）. The potential economic impact of VAP was high because of the significantly extended duration of ventilation. A predictive regression model was developed with a sensitivity of 95.3% and a specificity of 69.4%. VAP is common in patients who are undergoing SHNC and who require more than 48 h of mechanical ventilation. Therefore, innovative preventive measures should be developed and applied in this high-risk population.展开更多
文摘OBJECTIVE:To assess the long-term effectiveness of Huangqi(Radix Astragali Mongolici,HQ)-based Traditional Chinese Medicine(TCM)in the treatment of diabetic peripheral neuropathy(DPN).METHODS:Nine databases were searched to retrieve available randomized controlled trials that compared HQbased TCM and Western Medicines in the treatment of DPN.The methodological quality of the included studies was assessed using the Cochrane bias risk tool,and RevMan 5.4 was used for data analysis.The effect estimates of interest were risk ratio(RR),mean difference(MD)or standardized mean difference(SMD)with 95%confidence interval(CI).RESULTS:The results from 48 available studies assessing 3759 patients demonstrated that cases administered HQ-based TCM[RR=1.30,95%CI(1.21,1.40),P<0.00001]or HQ-based TCM combined with Western Medicines[RR=1.25,95%CI(1.19,1.31),P<0.00001]exhibited higher total efficacy rates than individuals who received Western Medicine alone.The results showed that the HQ-based TCM group had decreased Toronto Clinical Scoring System scores[MD=-1.50,95%CI(-1.83,-1.17),P<0.00001],and reduced serum interleukin 6[SMD=-0.57,95%CI(-0.87,-0.27),P=0.0002]and tumor necrosis factors-αlevels[SMD=-0.60,95%CI(-0.95,-0.25),P=0.0009].In addition,both HQ-based TCM and HQbased TCM combined with Western Medicine increased nerve conduction velocity and decreased glycaemia compared with Western Medicine alone.In terms of blood lipids,oxidative stress and adverse drug reactions,there were no significant differences between the HQ-based TCM groups and the Western Medicine control group.CONCLUSION:The current Meta-analysis revealed that HQ-based TCM yields higher efficacy and safety than Western Medicine alone for the treatment of DPN,although further well-designed RCTs are required to validate these findings.
基金This research＇was supported by the grants from the National Natural Science Foundation of China （No. 71473003）, and National Natural Science Foundation of China （71774001）.
文摘Background： China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis （DEA） model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development. Methods： We chose 12 country-level hospitals based on geographical distribution and the economic development level inAnhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions. Results： During 2010-2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was 〉1, and the rest are 〈1 between 2010 and 2015. Conclusions： In 2010-2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.
基金This research was supported by grants from Anhui Provincial Natural Science Foundation （No. 1408085MG143）, Anhui Provincial Natural Science Research Project in Universities, Anhui Education Department （No. K J2013A162）, and National Natural Science Foundation of China （No. 71473003）.Acknowledgment We would like to acknowledge the sampled hospitals, participants, team members, and undergraduates of the School of Health Services Management, Anhui Medical University for their support of and contributions to this research.
文摘Background： The self-consciousness and practicality of preferentially prescribed essential medicines （EMs） are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills （IM B） model to identify the predictors of essential medicines prescribing behavior （EMPB） among doctors and to examine the association between demographic variables, IMB, and EMPB. Methods： A cross-sectional study was carried out to assess predictive relationships among demographic variables and IM B model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the I MB model to test the instruments using analysis of moment structures 17.0. Results： A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old （range： 22-67 years old）. The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 a： 7.34 （hundred mark system： 75.77） and 19.92 ± 3.44 （hundred mark system： 79.68）, respectively. Approximately half（50.8%） of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data （x^2/df= 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066）. More work experience （β = 0.153, P 〈 0.001 ） and behavioral skills （β = 0.449, P 〈 0.001 ） predicted more EMPB. Higher income predicted less information （β = -0.197, P 〈 0.001） and motivation （β =0.204, P 〈 0.001 ）. Behavioral skills were positively predicted by information （β = 0.135, P 〈 0.001 ） and motivation （β = 0.742, P 〈 0.001 ）. Conclusion： The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.
文摘Patients undergoing major oncological surgery for head and neck cancer （SHNC） have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia （VAP） in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6~0 （n = 95） in patients who required more than 48 h of mechanical ventilation. Staphylococcus （37.7%）, Enterobacteriaceae （32.1%）, Pseudomonas （20.8%）, and Haemophilus （16.9~） were the major bacterial species that caused VAP. The independent risk factors for VAP were advanced age, current smoking status, chronic obstructive pulmonary disease, and a higher simplified acute physiology score system II upon admission. Tracheostomy was an independent protective factor for VAP. The median length of stay in the ICU for patients who did or did not develop VAP was 8.0 and 6.5 days, respectively （P = 0.006）. Mortality among patients who did or did not develop VAP was 16.8% and 8.4%, respectively （P 〈 0.001）. The potential economic impact of VAP was high because of the significantly extended duration of ventilation. A predictive regression model was developed with a sensitivity of 95.3% and a specificity of 69.4%. VAP is common in patients who are undergoing SHNC and who require more than 48 h of mechanical ventilation. Therefore, innovative preventive measures should be developed and applied in this high-risk population.
