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OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.
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OBJECTIVE To summariz e the expe rience of the ability training of prescription-auditing pharmacists in prescription pre-audit，and introduce the typical cases of the prescription-auditing pharmacists participating in the drug intervention. METHODS From October ，2020 to October ，2021，under the audit mode of “prescription pre-audit system+prescription-auditing pharmacists ” adopted by Yuxi People ’s Hospital （hereinafter referred to as “the hospital ”），the abilities of prescription-auditing pharmacists were cultivated from the aspects of training in pharmaceutical related professional knowledge ，training in the use of Chinese and English medical retrieval tools ，databases and websites ，and clinical thinking and communication ability ；through the construction of ability evaluation form of prescription-auditing pharmacists ，their abilities were assessed. RESULTS & CONCLUSIONS After one year ’s ability training ，the rational rate of prescription （doctor’s order ），the proportion of doctors ’active revision of problem prescription （doctor’s order ）and the doctor ’s acceptance rate of intervention by prescription-auditing pharmacists showed an upward trend ，the average time of irrational prescription （doctor’s order ）by prescription-auditing pharmacists showed a shortening trend ，and the intervention rate of prescription （doctor’s order ）showed a downward trend. In addition to the publication of papers （belonging to the bonus item ），the average score of the ability evaluation form of prescription-auditing pharmacists had significantly increased ， from 45.2 in October 2020 to 97.6 in October 2021.
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OBJECTIVE：To overview and analyze the current evidence of systematic reviews of drug treatment for children with tic disorder （TD），and to provide evidence-based reference for clinical practice. METHODS ：Retrieved from Medline ，Embase， CBM，CNKI，VIP and Wanfang database ，and so on ，systematic reviews about the efficacy and safety of drug treatment for TD were collected. AMSTAR- 2 tools were used to evaluate the quality of included studies ；the intervention measures ，diagnosis standard，outcome index ，the types of included studies ，main conclusion ，control measures ，effect sizes of different drug treatment were also extracted and analyzed descriptively. RESULTS ：A total of 27 systematic reviews were included ，of which 5 were medium-quality，8 low-quality and 14 very-low-quality. Meta-analysis showed that although typical psychiatric drugs could control tic symptoms ，ADR were prominent and the safety was not good ；risperidone and aripiprazole as atypical psychiatric drugs had good efficacy and safety ，and the research evidence was relatively sufficient. Clonidine as α2 adrenergic agonist could effectively control tic symptoms with fewer ADR ，especially for patients with affention deficit and hyperactivity disorder （ADHD），and research evidence was sufficient. Tiapride could effectively improve tic symptoms ，and the overall tolerance was better. Tomoxetine and methylphenidate could significantly improve the tic symptoms of tic patients with ADHD. CONCLUSIONS ：In the clinical treatment of TD in children ，ADR induced by typical antipsychotics are prominent and the safety is not good ；risperidone， aripiprazole，clonidine and tiapride have good efficacy and safety. Clonidine ，tomoxetine and methylphenidate could significantly improve tic symptoms of TD patients with ADHD. But the quality of systematic review methodology for tomoxetine and methylp- henidate is not good and further improvement is needed.
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OBJECTIVE：To compa re the effectiveness and safety of three regimens of tiapride ，clonidine and tiapride combined with clonidine in the treatment of tic disorder （TD）in children. METHODS ：A sequential collection of 312 children with TD from the outpatient department of West China Second Hospital of Sichuan University were conducted during Jan.-Dec. 2019. They were divided into clonidine group ，tiapride group ，tiapride combined with clo nidine group ，with 104 cases in each group. Tiapride group was given Tiapride hydrochloride tablets with initial dose of 50-100 mg per day ，and the dose was gradually increased to 150-500 mg per day according to tolerance and clinical experience. Clonidine group was given Clonidine transdermal patches ，once a week ，with initial dose of 1 mg each week ，maintenance dose of 1-2 mg each week ，once a week. Tiapride combined with clonidine group was given Tiapride hydrochloride tablets （same usage and dosage as tiapride group ）+ Clonidine transdermal patches （same usage and dosage as clonidine group ）. The treatment course of 3 groups was 3 months. After the treatment ，they were followed up every 3 months（the following were expressed as 24，36 and 48 weeks after treatment ）. Yale global tie severity scale （YGTSS）scores of 3 groups were observed before treatment ，after 4，8，12，24，36，48 weeks of treatment，and the occurrence of ADR was recorded at different follow up time points. RESULTS ：Before treatment ，there was no statistical significance in YGTSS scores among 3 groups（P＞0.05）. After 4，8，12，24，36 and 48 weeks of treatment ，YGTSS scores of 3 groups were significantly lower than those before treatment （P＜0.05）. After 4，8 and 12 weeks of treatment ，YGTSS scores of tiapride combined with clonidine group were significantly lower than tiapride group and clonidine group （P＜0.05），while there was no statistical significance between tiapride group and clonidine group （P＞0.05）. At 24 weeks of treatment ，YGTSS score of children in tiopride combined with clonidine group was significantly lower than tiopride group （P＜0.05），but there were no significant differences between tiopride combined with clonidine group and tiopride group ，and between tiopride group and clonidine group （P＞0.05）. After 36 and 48 weeks of treatment ，there was no significant difference in YGTSS scores among 3 groups（P＞0.05）. After 12 weeks of treatment ，the results of P value corrected by Bonferroni method showed that YGTSS score of tiopride combined with clonidine group was significantly lower than those of tiopride group and clonidine group （P＜0.016 7）， while there was no statistical significance in the difference between tiopride group and clonidine group （P＞0.016 7）. There was no statistically significant difference in the total incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：Clonidine，tiapride and tiapride combined with clonidine can significantly improve the tic symptoms of TD children with good safety .
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OBJECTIVE：To study the current status and influencing factors of medication compliance in children with tic disorder（TD），and to provide reference for improving medication compliance in TD children. METHODS：The questionnaire was designed according to the protection motivation theory. The cross-sectional study was adopted to conduct questionnaire survey among TD children in West China Second Hospital of Sichuan University from Jan. 2018 to Dec. 2019. The structural equation model was established according to the theoretical assumptions，and the maximum likelihood method was used to estimate the model；multiple linear regression analysis was carried out for the factors with significant influence in the single factor analysis，and path analysis and intermediary effect test were carried out. RESULTS：A total of 317 patients with TD were included，the mean age was（8.38±2.54）years，and the mean course of disease was（3.19±2.46）years. Average medication compliance scores was （5.70±1.69），among which 15.1％ was low compliance，37.5％ moderate compliance，and 47.3％ high compliance. Multivariate linear regression analysis showed that comorbidities（β＝0.124，SE＝0.167，P＝0.011），education level of the main guardian（β＝ 0.236，SE＝0.110，P＜0.001），quality of life（β＝0.399，SE＝0.112，P＜0.001）and the types of drugs taken（β＝0.166，SE＝ 0.047，P＝0.001）were the factors affecting medication compliance of children with TD. Structural equation model analysis showed that severity（β＝0.295，95％CI：0.103-0.493），external return（β＝0.830，95％CI：0.662-1.002），self-efficacy（β＝0.200，95％CI： 0.057-0.353），susceptibility（β＝0.220，95％CI：0.084-0.352）and quality of life（β＝0.353，95％CI：0.211-0.500）had a direct positive impact on medication compliance. Quality of life mediated between external returns and compliance variables（intermediary effect accounted for 13.9％ of the total effect value）. CONCLUSIONS：Children with TD have low medication compliance. It is recommended that pediatricians in medical institutions at all levels to manage the medication compliance of patients with TD from the severity，susceptibility，external returns and self-efficacy，so as to improve patients and guardians’awareness of the severity and susceptibility of disease and medication non-adherence，weaken external returns and increase self-efficacy，and ultimately improve medication compliance of patients
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OBJECTIVE：To evaluate t he c urrent status of the application of blockchain technology in China ’s pharmaceutical field，and to provide direction and decision support for its wide application and development in the domestic pharmaceutical field. METHODS：Retrieved from Embase ，PubMed，Cochrane library ，CBM，CNKI，VIP and Wanfang databases during the inception of databases to Sept. 30th，2019，the studies on application status of blockchain technology in China ’s pharmaceutical field were collected；descriptive analysis was conducted for research type ，publication time ，main research fields and existing problems. RESULTS & CONCLUSIONS ：A total of 60 literatures were included ，and all of them were Chinese literatures. Among them ，38 literatures were reviews ，19 were original researches ，2 were dissertation ，1 was conference paper. The publication time range was from 2016 to 2019. The application of blockchain technology in the main pharmaceutical fields is to promote the sharing of electronic medical record data ，personal health data ，clinical research data and genomic data ；the traceable path is mainly provided in medical insurance audits ，drug quality traceability and anti-counterfeiting ，medical devices and medical supplies traceability. These applications are still in the preliminary theoretical verification or trial stage. At present ，there are still some limitations or problems in the relevant policies and application standards ，data storage space and processing ，data privacy and security ，and professionals in China ’s pharmaceutical field. However ，it has high application value and potential in medical data sharing ， reducing treatment costs ， improving medical claim system ， strengthening medical management and optimizing medical decision-making.
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OBJECTIVE：To investigate the status quo and influential factors for scientific research training of pharmacists （nurses）in PIVAS of China ，to provide direction and reference for the development of PIVAS. METHODS ：The survey method was used to conduct a questionnaire survey of PIVAS pharmacist （nurses）from 29 tertiary and secondary hospitals in 24 provinces， autonomous regions ， municipalities from eastern ， western and central China through the i nternet by using self-designed questionnaire. The survey period was from Mar. to Apr. 2019. The survey content included the basic information （gender，region， hospital level ，professional and technical title ，education background ，employment nature ）of the survey participants and the status quo of scientific research training （frequency and content of scientific research training ，degree of need for scientific research ， degree of interest in scientific research ，etc.）and status quo of scientific research output （publication and application of the project）. Main influential factors for scientific research training were analyzed. RESULTS ：A total of 504 questionnaires were sent out，and 501 valid questionnaires were collected ，with effective response rate of 99.40％ . Totally 63.1％（316/501）of the respondents had scientific training ，and the frequency of scientific training was mainly less than one time/month （26.1％，131/501） and 1-2 times/month（25.0％，125/501）；72.1％（361/501）of the respondents have medium or above scientific research needs ， 82.4％（413/501）of the respondents have medium or above interest in scientific research ，only 6.0％（30/501）of the respondents had mastered the major scientific research methods ， only 5.4％（27/501）of the respondents thought that their scientific research ability were strong. The pharmaceutical re search - direction was mainly related to clinical rational use of drugs ， song_123@126.com less to precision medicine ，new drug and new dosage form： development， therapeutic drug monitoring research ， 028-85503220。E-mail：linyunzhu99@163.com translational medicine ， etc. Only 16.6％ （83/501） of the respondents had published articles after working in PIVAS ，and 9.0％（45/501）had applied for projects. There were statistical significances in the scientific research training among the respondents with different regions ，professional and technical titles ， educational backgrounds and employment natures （P＜0.05）. CONCLUSIONS ：The scientific research training of PIVAS pharmacist（nurses）in China is inadequate and the research output is low. Main influential factors for scientific research training include region ，professional and technical title ，educational background and employment nature .
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OBJECTIVE： To systematically evaluate the status quo of cost estimation in pharmacy intravenous admixture services （PIVAS）， and to provide cost basis for the construction of PIVAS in China. METHODS： Retrieved from PubMed， Embase， Cochrane library， CBM， CNKI， CSJD and Wanfang database from database establishment to Jan. 2019， the studies about the status quo of cost estimation in PIVAS of China were included. The descriptive analysis was conducted for content and method of cost estimation， infection to hospital. RESULTS： A total of 17 literatures were included， involving 8 before and after control studies， 6 experience sharing studies and 3 reviews. Existing reports showed that the estimation contents and methods of PIVAS cost were roughly the same. The cost included manpower， medical and health materials， fixed asset purchase， depreciation， repair costs， medicine cost and indirect costs. At the same time， the infection to hospital were reported， such as in manpower adopting， formulating detailed management measures and systems， concurrent allocation of the same kind of drugs， shortening infusion preparation and replacement time， in order to save manpower cost. CONCLUSIONS： PIVAS cost calculation method is roughly the same in some hospitals， but there is no uniform standard. It is necessary to further improve the PIVAS cost measurement standard and provide a basis for the construction and development of PIVAS in China.
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OBJECTIVE： To systematically evaluate the efficacy and safety of febustrin （80 mg/d and 40 mg/d） and allopurinol （300 mg/d） in the treatment of gout， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Embase， Cochrane library， CJFD， Wanfang database and CBM during from database establishment to Mar. 2019， randomized controlled trial （RCT） about efficacy and safety of febustrin 80 mg/d （trial group）， 40 mg/d （observation group） and allopurinol 300 mg/d （control group） in the treatment of gout were collected. After extracting data of clinical studies met inclusion criteria and quality evaluation with Cochrane system evaluator manual 5.1.0， Meta-analysis was conducted for blood uric acid decrease level， the compliance rate of serum uric acid concentration， incidence of liver dysfunction， incidence of renal dysfunction， incidence of digestive tract reaction and frequency of acute gout attack with Rev Man 5.1 software and Stata 13.0 software. RESULTS： A total of 17 RCTs were included， involving 1 816 patients. Meta-analysis results showed that， the serum uric acid decrease level of patients in trial group [MD＝－70.17， 95％CI （－97.41， －42.93）， P＜0.001] and the compliance rate of serum uric acid concentration [RR＝1.58， 95％CI （1.20， 2.08）， P＝0.001] were higher than observation group； the decrease of serum uric acid level [MD＝－34.68，95％（－61.35， －8.00）， P＝0.01] and the compliance rate of serum uric acid concentration [RR＝1.39，95％CI（1.04，1.85）， P＝0.03] in trial group were significantly higher than control group； the frequency of acute gout attack [RR＝1.54（1.02，2.31）， P＝0.04] in trial group was significantly higher than observation group. The incidence of liver dysfunction in observation group [RR＝0.71，95％CI（0.52，0.99），P＝0.04] was significantly lower than control group， with statistical significance. There was no statistical significance in other indexes among other indexes （P＞0.05）. CONCLUSIONS： Compared with febulostat 40 mg/d and allopurinol 300 mg/d， the efficacy of febulostat 80 mg/d is superior in reducing uric acid levels of gout patients.
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OBJECTIVE： To systematically evaluate current status of charges in pharmacy intravenous admixture services （PIVAS）， and to provide reference for the formulation of China’s pharmacy intravenous admixture services （PIVAS） charging standards. METHODS： Retrieved from PubMed， Embase， Cochrane library， CBM， CNKI， VIP， Wanfang database and related goverment websets， the literatures about current status evaluation of charges in PIVAS of China were collected during the establishment of database to Jan. 2019. Cost estimation， charge standard， influential factors and other indicators were collected， and the results were presented by descriptive analysis. RESULTS： A total of 5 literatures were included， all of which were reviewed. According to the existing literatures， except for Shandong， Guangdong and Yunnan provinces， there were no regional charge standards in other provinces （districts and cities）. The cost estimation methods of PIVAS in these three provinces were basically the same. The cost could be obtained by adding up the business fees， labor fees， fees of medical instruments purchase and use， indirect fees etc. Dispensing charges in PIVAS were 3-5 yuan per piece for general drug， 5 yuan per piece for antibiotics and 8-12 yuan per piece for cancer chemotherapeutics， 20-35 yuan per piece for TPN. The charging level was mainly affected by local prices， PIVAS scale， hardware investment， management and other factors. CONCLUSIONS： There is no unified charging standard for PIVAS in most provinces （districts， cities） of China. The cost estimation methods of the hospitals from the included literatures are basically the same. It is necessary to construct national PIVAS charging standard and cost estimation method， which could provide a basis for formulating the price of medical and health services.
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OBJECTIVE： To systematically evaluate the mode of personnel training in pharmacy intravenous admixture services （PIVAS） in China， and to provide reference for the comprehensive training of pharmacist in PIVAS in China. METHODS： PubMed， Embase， Cochrane Library， CBM， CJFD， VIP and Wanfang database were searched from the establishment of database to Sept. 2018. Studies which evaluated the training mode of PIVAS in China were included， and the results were presented by descriptive analysis in respects of training objects， training objectives， contents and evaluation indicators. RESULTS： A total of 5 literatures were included. The research types were 2 before-after control studies， 2 experience sharing studies and 1 review. 3 subjects were pharmacists， 1 subject was clinical pharmacists， and 1 subject was nurses. The training objectives were comprehensive quality training， clinical rational drug use level， pharmacy personnel training path and professional service ability. The specific training content of the training mode varied greatly， including professional theoretical knowledge， practical operation ability， pre-job training， professional psychological quality， professional ethics and laws and regulations， continuing education learning ability， career development planning and teaching ability. There were great differences in the evaluation indicators of training effectiveness， which were mainly reflected in team execution motivation and creativity， discoveny rate of unreasonable doctor’s advice， work efficiency， service quality， drug treatment level and satisfaction of PIVAS， etc. CONCLUSIONS： There are certain differences in the training objectives， training targets， specific contents and evaluation indicators of the PIVAS pharmacist training model in China. It is necessary to use the evidence- based method to construct the training mode for PIVAS pharmacist to provide support for clinical intravenous drug use.
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OBJECTIVE： To systematically evaluate the efficacy and safety of Clonidine tansdermal patch for child tic disorders in children， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from Medline， Embase， Cochrane library， CNKI， VIP， CBM and Wanfang database， randomized controlled trials （RCTs） about Clonidine tansdermal patch （trial group） versus other therapies （control group， including placebo group， thiopride group， haloperidol group） for child tic disorders were collected from datbase estallishment to July 2018. The literatures met inclusion criteria were summarized. After quality evaluation with Cochrane system evaluation manual 5.1.0， Meta-analysis of reduction rate （amount） of YGTSS， the incidence of ADR and response rate was performed by using Rev Man 5.3 statistical software. Descriptive analysis was performed on indicators of groups that were unable to perform Meta-analysis. RESULTS： A total of 8 RCTs involving 1 320 patients were included. Among them， 2 RCTs involved placebo in control group； 2 RCTs involved thiopride， 3 RCTs involved haloperidol， and 1 RCT involved thiopride and haloperidol. Results of Meta-analysis showed that reduction rate of YGTSS in trial group were significantly higher than haloperidol group [MD＝21.94， 95％CI（21.03， 22.86）， P＜0.001]， but there was no statistical significance compared with thiopride group [MD＝10.66， 95％CI（－15.68， 37.00）， P＝0.43]. The incidence of adverse events （mainly including skin itching， redness， dry mouth， dizziness， decreased blood pressure， abnormal electrocardiogram） in trial group were significantly lower than thiopride group [OR＝0.42， 95％CI（0.22， 0.82）， P＝0.01] and haloperidol group [OR＝0.17， 95％CI（0.09， 0.32）， P＜0.001]， but there was no statistical significance compared with placebo group [OR＝0.61， 95％CI（0.29， 1.29）， P＝0.20]. There was no statistical significance in response rate of trial group compared with thiopride group [OR＝1.29，95％CI（0.38， 4.39）， P＝0.69] and haloperidol group [OR＝1.63， 95％CI（0.89， 2.96）， P＝0.11]. The results of descriptive analysis showed that reduction rate （amount） of YGTSS in trial group was significantly higher than that of placebo group （P＜0.05）， and response rate of trial group was significantly higher than that of placebo group （P＜0.01）. CONCLUSIONS： For child tic disorders in children， Clonidine tansdermal patch is better than placebo and haloperidol in reduction rate （amount） of YGTSS， and is similar to thiopride. Response rate of Clonidine tansdermal patch is better than that of placebo， and is similar to those of thiopride and haloperidol. The safety of Clonidine tansdermal patch is better than those of thiopride and haloperidol， and is similar to that of placebo.
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OBJECTIVE:To evaluate the indicators of ADR reporting by medical institutions in China. METHODS:The indicators of ADR reporting by medical institutions in China were presented primarily by 8 pharmacy experts with focus group interview method. System assessment method was used for evidence-based analysis of primary ADR indicators. Delphi method was used to confirm the requirement,calculation formula,definition,evaluation meaning and reference value of ADR indicators. The reliability was assessed. RESULTS:Primary indicators included the rate of ADR reporting,the rate of qualified ADR,constituent ratio of severe and new ADR. A total of 30 literatures were included(15 documents of management standard,15 literature research)in system evaluation,all of which indicated the necessity and requirement of ADR reporting. But the calculation formula, definition and evaluation meaning of ADR indicators were not mentioned. By investigation with Delphi method,the range of reference value was confirmed as follows that the rate of ADR reporting was≥0.01%;the rate of qualified ADR was≥90%;the constituent ratio of severe and new ADR was≥1%. The evaluation result was reliable. CONCLUSIONS:The indicators of ADR reporting and reference lower limit value can urge medical and health institutions to report ADR actively,improve the quality of ADR reporting and strengthen the attention of medical and health institutions to severe and new ADR.
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OBJECTIVE:To evaluate the effectiveness and safety of bromocriptine by vaginal delivery in the treatment of hyperprolactinemia in Chinese female patients,and to provide evidence-based reference for clinic.METHODS:Retrieved from PubMed,The Cochrane Liabmry,Excerpta Medica Database,Chinese Journal Full-text Database,Wanfang Database and China Bxdxiology Medicine disc,randomized controlled trials (RCTs) about bromocriptine oral tablets by vaginal delivery (trial group) vs.bromocriptine by oral administration (control group) in the treatment of bromocriptine in Chinese female patients were collected.After data extraction,quality evaluation of included studies with Cochrane system evaluator manual 5.1.0,Meta-analysis of serum level of Prolactin levels,the rate of menstruation improvement,the rate of pregnancy recovery,the rate of galactorrhea disappearance,the incidence of ADR in digestive tract and the incidence of ADR in nervous system was conducted by using Rev Man 5.1 statistical software.RESULTS:A total of 16 RCTs were included,involving 1 175 patients.The results of Meta-analysis showed that the incidence of ADR in digestive tract [OR=0.14,95％CI(0.09,0.23),P＜0.001] and ADR in nervous system [OR=0.32,95％CI(0.11,0.90),P=0.03] in trial group were significantly lower than control group,with statistical significance.There was no statistical significance in serum level of PRL [MD=0.24,95％ CI (-0.94,1.41),P=0.69],the rate of menstruation improvement [RD=0.04,95％CI (-0.04,0.11),P=0.32],the rate of pregnancy recovery [RD=0.01,95％CI (-0.08,0.10),P=0.84] or the rate of galactorrhea disappearance [RD=0.05,95％ CI (-0.03,0.13),P=0.20] between 2 groups.CONCLUSIONS:Compared with oral administration,bromocriptine by vaginal delivery has no significant difference in therapeutic efficacy but has obvious advantages in the incidence of ADR in digestive tract and in nervous system and better safety.It is suggested to development the special vaginal delivery preparation of bromocriptine.
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OBJECTIVE:To systematically review the current situation and facing problems of hierarchical diagnosis and treat-ment in China,and provide basis for nation health-related decisions. METHODS:Using"hierarchical diagnosis and treatment"as keyword,relevant literatures in CNKI,VIP database,and Wanfang database from building to Jun. 2016 were retrieved. Study for current situation of hierarchical diagnosis and treatment in China was comprehensively collected,and systematical review was con-ducted from aspects of outcome evaluation indicators and facing problems. RESULTS:Totally 23 studies were included,in which, 18 were investigative studies,3 were retrospective/investigative studies,1 was retrospective study,and 1 was randomized con-trolled study. In the outcome evaluation indicators,9 took awareness of hierarchical diagnosis and treatment as review indicators, showing that the public had poor awareness;7 took the current situation as review indicator,showing that the overall current situa-tion was unsatisfactory;3 took human resources as review indicator,showing that human resources in primary medical institutions were not ideal;3 took satisfactory degree as review indicator,showing that the public were generally satisfied with hierarchical di-agnosis;2 took the implementation model as review indicator,showing that the current model had been able to promote hierarchi-cal diagnosis and treatment;2 took medical cost as review indicator,showing that individuals paid higher. In the facing problems, 19 studies suggested the imperfect systems for hierarchical diagnosis and treatment,16 suggested that primary medical treatment was limited in capability,7 suggested that patients still preferred big hospitals to primary medical institutions,and 7 suggested that it lacked publicity. CONCLUSIONS:The current situation of hierarchical diagnosis and treatment is certainly not ideal but still fac-ing many problems in China. Improving the levels in primary institutions,hierarchical diagnosis and treatment system and patients' willingness to primary medical institutions,and increasing its publicity can deeply promote the implementation of hierarchical diag-nosis and treatment and provide objective and valuable reference for health decision-making.
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Objective To evaluate the efficacy and safety of Radix Astragali(Huang Qi)for newborns with hypoxic ischemic encephalopathy(HIE). Methods We searched the Cochrane library,PubMed,Cochrane,EMBASE,CBM,CNKI,VIP and Wan?fang database,randomized controlled trial(RCT)evaluating the efficacy and safety of Huang Qi for newborns with HIE would be in?cluded and the methodological quality of RCT was evaluated according to the Cochrane Handbook for Systematic Reviews of Interven?tions version 5.1.0. Results Thirteen studies were included(1031 patients),11 RCT used open control as control,2 RCT used posi? tive control. There was no trial reported the death or disability at the end of 12 months follow-up period. Meta-analysis of one study showed Huang Qi group could not significantly reduced mortality rate of HIE compared with open control group〔RR=0.33,95%CI (0.04,3.07)〕. Meta analysis of 7 studies(n=597)showed that the efficacy rate of huang Qi group was significantly higher than that of open control group in treatment of HIE〔RR=1.22,95%CI(1.07,1.39),I2=48%〕. Meta-analysis of 3 trials(n=163)showed that there was significant difference in the improvement of NANA scale on the seventh day〔MD=5.37,95%CI(1.46,9.27),I2=89%〕be?tween Huang Qi group and open control group. Meta-analysis of 2 trials(n=111)showed that there was significant difference in the im?provement of NANA scale on the tenth day〔MD=2.03,95%CI(1.37,2.69),I2=0〕between Huang Qi group and open control group. No fatal side effects were reported. Conclusion Based on the current evidence,due to the limitation of quality of included studies and sample size,the routine use of Huang Qi for treatment of HIE in newborns is not recommended. The long-term efficacy and safety studies are required to confirm it.