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Rituximab, a chimeric human-mouse monoclonal antibody, has been used as a first-line treatment for CD20
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Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
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Humans , Anti-Bacterial Agents/therapeutic use , China , Drug Monitoring/methods , Polymyxin B , Practice Guidelines as TopicABSTRACT
AIM: To investigate the effect of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics/pharmacodynamics (PK/PD) of daptomycin in critically ill patients. METHODS: Twenty four patients with severe infection in our hospital were randomly selected and divided into ECMO group and non ECMO group. They were intravenously injected with daptomycin 500 mg qd. After the drug reached the stability statement, venous blood was collected at different time points before and after the infusion. The plasma drug concentration was measured and the pharmacokinetic parameters were calculated. The probability target acquisition (PTA) and the cumulative fraction response (CFR) were calculated by Monte Carlo simulation. RESULTS: After dosing, the main pharmacokinetic parameters in ECMO and non-ECMO group were calculated and listed as follows: C
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AIM: To establish an ultra high performance liquid chromatography (UPLC) method for the determination of micafungin in plasma of critically ill patients. And to establish a model for estimating the area under the concentration-time curve (AUC) of micafungin by limited sampling strategy. METHODS: Patients with severe infection were administrated with micafungin once a day, 1 h for each infusion. The blood samples were collected before administration and 1, 2, 4, 8, 12, 24 h after administration and were measured by UPLC. The pharmacokinetic parameters were calculated by Phoenix winnonlin 6.4, and the drug concentrations at 2-4 blood collection points were analyzed with SPSS 22.0 to establish limited sampling models. RESULTS: The calibration curve was linear over a concentration range of 1.0 to 50 μg/mL (r
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Objective:To understand the practice of humanistic care and social worker voluntary service in public hospitals in China.Methods:From January to March 2021, 38 typical cases concerning " medical social worker and volunteer system" and " building a harmonious doctor-patient relationship through humanistic service" were collected by relying on the evaluation of China Healthcare Improvement Initiative. By means of statistics on the frequency of the subject words in the cases, hotspots of these hospitals in " paying attention to medical humanistic care and promoting social work voluntary service" were identified.Results:By classifying the keywords of the 38 cases, the hotspots mainly focused on strengthening the construction and management of social work volunteer platform and team, providing convenient and high-quality services, integrating humanistic care into diagnosis and treatment services, and building characteristic brand projects.Conclusions:The concept of humanistic care should be integrated into the hospital culture construction, the standardized and institutionalized development of humanistic care and volunteer work in the hospital should be promoted. Supporting measures should be introduced to promote the professional and stable development of talent team, and the routine service system should be established based on the needs assessment of both doctors and patients.
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Objective:To analyze the practice and experience of " patient-centered, popularizing multi-disciplinary team(MDT) mode" in medical institutions, and to put forward reasonable suggestions and opinions for medical institutions to further improve and popularize MDT mode.Methods:Based on the evaluation of China Healthcare Improvement Initiative, 40 typical cases of MDT in medical institutions were collected, and descriptive analysis and textual analysis were carried out on the cases.Results:There were more specialized hospitals carrying out MDT, the application scope of MDT services was constantly expanding, and the management system and diagnosis and treatment process were constantly optimized.Conclusions:The mode of MDT in China is in the stage of exploration and development. In the promotion process, it is necessary to give full play to the role of information means, establish scientific and reasonable cost measurement and charge standard, and improve the enthusiasm of medical institutions and medical personnel to participate in MDT.
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Objective:To understand the changes in the practice environment from the perspective of doctors in 136 tertiary public hospitals, and to provide evidence for formulating strategies and measures to improve the practice environment of doctors.Methods:The data was collected from five rounds of China Healthcare Improvement Evaluation Survey from December 2015 to March 2021. The sample size was 17 945, 19 774, 20 786, 23 289, and 22 836, with a total of 104 630. The self-designed questionnaire on four dimensions of doctor-patient relationship, workload, administrative logistics support and professional identity was performed.Results:From the 1st to the 5th survey, the approval ratio of " the administrative and logistics department of this hospital is highly efficient" showed the characteristics of " U-shaped distribution" , and the approval ratio of " approve or encourage children to continue to engage in medical work" increased from 13.38% to 23.91%.From the 2nd to the 5th survey, the percentage of doctors who experienced doctor-patient disputes dropped from 28.96% to 23.20%, and the percentage of doctors agreeing that the relationship between doctors and patients in this hospital was improving continued to increase from 33.20% to 60.45%.From the 3rd to the 5th survey, the proportion of doctors experiencing medical troubles dropped from 15.10% to 14.19%, and the recognition rate of " the cafeteria of this hospital provided medical staff with nutritious and delicious meals" increased from 36.25% to 47.52%, and the approval proportion of " my current work load is heavy" dropped from 61.55% to 45.24%. The results of the 5th survey showed that there were significant differences in the approval ratios of each dimension in different genders, job titles and hospital types( P<0.001). Conclusions:From the perspective of doctor-patient relationship, workload, administrative logistics support, and professional identity, the improvement of doctors′ practice environment is still insufficient. Hospital administrators should continue to focus on the improvement of the doctor-patient relationship, and take necessary measures to reduce doctors′ workload and improve doctors′ professional identity.
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Objective:To analyze the salary level, change trend and salary satisfaction of nurses in tertiary public hospitals in China.Methods:The data was derived from three round third-party evaluation of the China Healthcare Improvement Initiative at 136 tertiary public hospitals from December 2017 to January 2018, March 2019 and January to March 2021. The self-reported salary, expected salary and salary satisfaction rate of nurses were analyzed.Results:The sample sizes of the three evaluations were 27 575, 27 568 and 25 197, representing the salary situation in 2017, 2018 and 2020 respectively. In 2017, 2018 and 2020, the actual average annual salary of nurses was 81 600 yuan, 100 000 yuan and 110 000 yuan respectively, the expected average annual salary was 140 000 yuan, 160 000 yuan and 160 000 yuan respectively, and the ratio of expected salary to actual salary was 1.72, 1.60 and 1.45 respectively. In 2017, 2018 and 2020, the proportion of nurses satisfied with their current income was 34.0%, 33.7% and 43.6% respectively. In 2020, nurses in the eastern region, other specialized hospitals, senior professional titles and graduate degrees had highest annual salary.Conclusions:The salary level and satisfaction rate of nurses in tertiary public hospitals in China show a slow growth trend, and the gap between actual salary and expected salary is gradually narrowing.
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Objective:To analyze the current level and dynamic change of the salary and income satisfaction rate of doctors in Chinese tertiary public hospitals in recent years.Methods:In January 2018, March 2019 and March 2021, the project team of " the third party evaluation of the China Healthcare Improvement Initiative" conducted a questionnaire survey among doctors of 136 tertiary public hospitals in 31 provinces. The first-line clinicians were investigated by stratified sampling method. The salary level and satisfaction of doctors were investigated by questionnaire. Chi square test was used for comparison between groups.Results:The sample size of the three surveys was 20 786, 23 289 and 22 836 respectively. The median value of doctors′ actual income after tax in 2017, 2018 and 2020 was 100 800 yuan, 120 000 yuan, 150 000 yuan respectively, and the median expected annual income after tax was 196 000 yuan, 250 000 yuan and 250 000 yuan. The proportion of doctors satisfied with the current income was 16.5%, 17.8% and 26.9% respectively. The salary and satisfaction rate of doctors had an upward trend, but the overall level was still low.Conclusions:In recent years, the salary of doctors in tertiary public hospitals in China has been improved to a certain extent, but on the whole, it is at a low level, and there is still much room for improvement. In the future, the government needs to improve the hospital salary system and increase the salary of doctors continuously, especially needs to pay attention to the doctors with high education level and intermediate titles.
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Objective:To investigate the patient satisfaction at tertiary cancer hospitals in China, and explore its determinants.Methods:Based on the fifth third-party evaluation of China Healthcare Improvement Initiative, an inpatient satisfaction survey was conducted from January 2021 to March 2021 in 33 tertiary cancer hospitals in China. Inpatient satisfaction was analyzed, and Chi-square test and binary multivariate logistic regression were run, using the level of overall inpatient satisfaction as a dependent variable.Results:A total of 5 417 inpatients in tertiary cancer hospitals was recruited with 49.8% men. The inpatient at the age of 35-59 accounted for 56.0%, and they were 52.8±13.9 years old. The level of overall inpatient satisfaction was 98.90%. The inpatient satisfaction rates of meal service, waiting time for admission and psychological counseling service provided by hospital were relatively poor, which were 78.75%, 92.40% and 94.11%, respectively. The regression showed that level of overall inpatient satisfaction in the central and western regions(compared with eastern area), with urban and rural residents basic medical insurance or other type(compared with urban employee basic medical insurance), of breast cancer patients(compared with other disease), with unsured postoperative metastasis(compared with non-postoperative metastasis), with low self-rated health score(compared with the score of between 81 and 100)was lower.Conclusions:The inpatients in tertiary cancer hospitals in China is highly satisfied with the care provided. In the future, more attention should be paid to the dimension of lower patient satisfaction, such as diet and psychological counseling.
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Objective:To analyze the status quo, trend and influencing factors of patient satisfaction in tertiary maternity and child hospitals in China.Methods:Based on the survey results of five round third-party evaluations of the China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on the satisfaction index in tertiary maternity and child hospitals, and the influencing factors of satisfaction were analyzed based on the results of the fifth evaluation.Results:Compared with the first round, the overall patient satisfaction in tertiary maternity and child hospitals in the fifth round was improved(inpatient: from 95.7% to 98.0%; outpatient: from 87.8% to 94.9%). Outpatient satisfaction varied significantly among gender, hospitals of different types, education level, types of treatment, medical insurance and doctors′ titles( P<0.05). Outpatient satisfaction in local hospitals was 1.502 times higher than that in hospitals under the National Health Commission. The satisfaction of referrals was 0.259 times lower than that of patients who were admitted directly. Inpatient satisfaction varied significantly among department, hospitals of different regions, household registration type and whether the admission was delayed due to the COVID-19 epidemic( P<0.05). The satisfaction of inpatients in medical ward and surgical ward was respectively 0.202 and 0.298 times lower than that of inpatients in pediatric ward. Inpatient satisfaction at the central regions was 3.311 times higher than that at the eastern regions. Conclusions:The overall patient satisfaction in tertiary maternity and child hospitals in China is improving. In the future, we should pay more attention to the hospital environment, humanistic care and other non-medical service dimensions with low satisfaction, so as to further improve the medical experience of patients in maternity and child hospitals.
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Objective:To explore the change trend of patients′ recognition of the medical reform effect and medical staff′s occupation and its relationship with medical experience, since the implementation of the China Healthcare Improvement Initiative(CHII), so as to provide reference for exploring the breakthrough point of consolidating the reform effect.Methods:Four indicators of the third-party assessment of patients were selected, which were " I think the medical reform has benefited patients" , " I think the doctor-patient relationship is improving in the past three years" , " I think medical personnel deserve social respect and recognition" , and " I am willing to let my children join the medical profession" . Descriptive and trend analysis were carried out on the survey results, and correlation analysis was carried out between the survey results and patients′ medical experience.Results:Compared with the baseline evaluation results(76.9% and 69.9%for outpatients, 87.3% and 85.6%for inpatients), the patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship in the fifth evaluation(86.2% and 89.1%for outpatients, 91.4% and 92.6%for inpatients)were significantly improved. The proportion of patients who thought the medical staff was worthy of respect and willing to let their children work in the hospital in the fifth evaluation(97.4%, 79.1%for outpatients, 98.7%, 85.1%for inpatients)were higher than the baseline evaluation results(92.3%, 71.0%for outpatients, 98.1%, 81.6%for inpatients). The above indicators were positively correlated with the patient′s medical experience.Conclusions:Since the implementation of CHII, patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship has been continuously improved, and patients′ respect and recognition of professional identity of medical personnel is at a high level and continues to improve. Improving medical experience has a positive effect on the improvement of patients′ sense of medical reform.
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Objective:To evaluate the implementation of the China Healthcare Improvement Initiative(CHII)from 2018 to 2020 in 143 tertiary public hospitals in China.Methods:In March 2019 and from January to March in 2021, 143 tertiary public hospitals in 31 provinces of China were investigated using the unified " medical institution questionnaire Ⅰ" and " medical institution Questionnaire Ⅱ" . The data were collected by means of hospital self-report and expert on-site scoring. Descriptive and inferential statistical analysis were used to analyze the data, and the data of two cross-sectional surveys were compared and analyzed.Results:The average score rate of implementing CHII in 143 sample hospitals in 2020 was 88.9%, which was higher than that in 2018(84.4%). The appointment diagnosis and treatment system, clinical pathway management system, day service, smart hospital and humanistic service were significantly improved. In 2020, the average score rate of logistics service, high quality nursing service and clinical pathway management system was higher than 95%, while the average score rate of day service, telemedicine system and medical social work system was lower than 85%. The total score rate of general hospitals was significantly higher than that of specialized hospitals( P<0.001). In 2020, the proportion of hospitals with full marks in 29 secondary indicators(74.4%)was more than 80%, reaching the standard level. Conclusions:The implementation level of CHII in tertiary public hospitals in China has been improved continuously and made significant progress, but some dimensions and indicators need to be further improved.
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Objective:To assess the progress and impact of the China Healthcare Improvement Initiative(CHII) from 2015 to 2020, which aimed at improving patients healthcare experiences.Methods:Five rounds of evaluation surveys were conducted from December 2015 to March 2021 among 136-214 tertiary public hospitals. Structured questionnaires to measure hospital actions and performance, satisfaction of patients and medical staff were designed, and the data were collected by the national and provincial survey teams via onsite inspection, face-to-face/telephone interviews and self-administered cellphone APPs respectively. After data cleaning, the results of five round evaluations were analyzed and compared.Results:The sampled hospitals demonstrated high participation rate in the CHII, and their overall performance turned out to be satisfactory. And the patient healthcare experiences consistently improved over the period of CHII. In contrast to the high satisfaction rate with clinical quality of the sampled hospitals, patients were less satisfied with the non-clinical services such as food and supporting services. The job satisfaction of doctors and nurses experienced mild improvements, while the problems of heavy workload, low salary, and poor health were not effectively solved yet.Conclusions:The implementation of CHII from 2015 to 2020 has played a significant role in promoting patient-centered service models in hospitals, but continuous inputs and coordinated efforts are still required in the future. The improvement of non-clinical services still needs to be addressed to further enhance patient satisfaction. The job satisfaction and well-being of doctors and nurses remain at low level, and effective measures need to be taken to maintain the stability of the medical staff.
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Objective:To evaluate the reliability and validity of the Chinese version of the continuity assessment record and evaluation(CARE)among the elderly in nursing institutions.Methods:A total of 269 elders in nursing institutions were face-to-face interviewed.Information was collected with the Chinese version of CARE, the mini mental state examination(MMSE), the geriatric depression scale(GDS), the visual analogue pain score(VAS), the barthel index(BI), the lawton instrumental activities of daily living scale(IADL), and the euroqol five dimensions questionnaire(EQ-5D). A week later, 30 of the elderly were re-evaluated with the Chinese version of CARE.Data were analyzed for reliability and validity.Results:For both the total score and the score for each dimension of CARE, the interrater reliability and test-retest reliability expressed by the intraclass correlation coefficient(ICC)ranged from 0.945 to 1.000 and 0.842 to 1.000, respectively; the internal consistency expressed by Cronbach's α ranged from 0.717 to 1.000, all reaching good levels of reliability.The criterion-related validity of the relevant dimensions of CARE showed high correlations with MMSE, GDS, VAS, BI, IADL and EQ-5D(0.918, 0.802, 0.998, 0.931, 0.924 and 0.917, respectively)(all P=0.000). Conclusions:The Chinese version of CARE has good reliability and validity among elders in nursing institutions, and can be used as a comprehensive assessment tool for the elderly in nursing institutions in China.
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Epidemiological survey shows that the prevalence, incidence rate and symptoms of mental disorders are affected by sex. A large number of studies have shown that men and women respond differently to psychotropic drugs in clinical application. Moreover, some studies have shown that there are sex specific psychotropic drug use patterns in patients with depression. This paper summarizes the sex differences in pharmacokinetics of psychotropic drugs caused by physiological differences between men and women, and collates the current pharmacodynamic studies of mainstream clinical psychotropic drugs, with special attention to the effect of sex hormones on the therapeutic response of psychotropic drugs. This paper discusses the specific role and necessity of therapeutic drug monitoring in dealing with clinical sex differences in psychotropic drugs, hoping to provide reference for individual rational drug use.
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AIM: To explore the clinical efficacy of three different kinds of Chinese patent medicines combined with tacrolimus and hormone in the treatment of nephrotic syndrome (NS). METHODS: A total of 199 patients with NS treated in department of nephrology of our hospital from January 2018 to December 2020 were analyzed retrospectively. All patients were treated with tacrolimus combined with hormone regimen for 12 weeks. According to different treatment schemes, they were divided into 4 groups: 57 cases in the control group, 51 cases in the Bailing capsule group (Bailing group), 55 cases in the Huangkui capsule group (Huangkui group) and 36 cases in the Wuzhi capsule group (Wuzhi group). The general data of patients, the biochemical indexes before and after treatment, and the tacrolimus blood concentration were collected. RESULTS: After 12 weeks of treatment, 24 h UTP and ALB of each group were statistically different (P<0.01). Compared with the control group, Bailing group had statistically significant differences in the reduction of TG and TC (P<0.05), Huangkui group had statistically significant differences in the reduction of 24 h UTP and serum TC (P<0.05), Wuzhi group had statistically significant differences in the reduction of 24 h UTP and AST (P<0.05). The steady-state trough concentration (C
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Objective@#To carry out the 4th round of third-party evaluation on the implementation and effect of the 1st year of the 2nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015.@*Methods@#The 4th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations.@*Results@#The 4th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved.@*Conclusions@#The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.
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OBJECTIVE: To study the correlation of common cardiovascular risk factors with brain iron deposition. METHODS: Eighty-four elderly subjects without neurological diseases or brain trauma were included in the study. The cardiovascular risk factors were comprehensively assessed. MRI examination was performed to obtain high-resolution T1-weighted images and enhanced susceptibility weighted angiography (ESWAN) images, and R2* figure was obtained by post-processing the ESWAN sequence. High definition T1 images were segmented using computer segmentation technique. After registration to the ESWAN image, R2* values of each region of interest were extracted. Multiple linear regression analysis was used to analyze the relationship of R2* values in each area of interest with gender, age and vascular risk factors. RESULTS Smoking was associated with increased R2* values in the hippocampus, white matter and cortex (β=0.244, 0.317, 0.277, P<0.05 or P<0.01). Hypertension was correlated with the increase of R2* in the putamen (β=0.241, P=0.027). Hyperglycemia was associated with the increase of R2* in the thalamus (β=0.234, P<0.05). In the thalamus, the R2* value of males was higher than that of females (β=0.320, P<0.05). Age was correlated with the R2* values of thalamus, caudate nucleus, pallidus, white matter and cortex (β=-0.218、-0.254、0.216、-0.280 and -0.238, P<0.05 or P<0.01). CONCLUSIONS Common cardiovascular risk factors may lead to iron deposition in the brain, and the deposition patterns vary with the gender, age and different risk factors.
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Objective To carry out the 4th round of third-party evaluation on the implementation and effect of the 1st year of the 2nd Phase National Healthcare Improvement Initiative ( abbreviated as Initiative) since 2015. Methods The 4th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations.Results The 4th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces ( autonomous regions, municipalities directly under the Central Government ) and Xinjiang Production and Construction Corps. Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1% , 96.7% for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.