Application and evaluation of management mode for the use of antimicrobial drugs in county-level medical communities led by anti-infective clinical pharmacists / 中国药房

OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

Exploration on Optimizing "Five-sphere" Medical Humanistic Care Service in Medical and Nursing Institutions / 中国医学伦理学

The combination of medical care and nursing is an important measure of health care for the aged, and it is also an important part of aging work. Under the background of increasing aging, and under the background of changing from disease-centered and patient-centered medical model to health-centered "big medicine" model, medical humanities are particularly important for how to make the elderly spend their old age in peace and make the road of combining medical care with nursing care wider. Based on the practice of combination of medical care and nursing, under the guidance of the concept of great health, this paper discussed the establishment of a "Five-sphere" all-round humanistic care concept integrating medical care, nutrition care, sports care, mental care and other convalescent health care factors, and provided a series of comprehensive multi-angle humanistic care service measures from physiology to psychology for elderly patients with chronic diseases, which has achieved good results.

Occupational health management of radiation workers in non-medical institutions in Shanxi Province, China / 中国辐射卫生

Objective To understand the basic information of the number, classification, and distribution of radiation work units in non-medical institutions in Shanxi Province, China, and to analyze the status quo of health management and radiation protection measures for radiation workers, so as to provide a scientific basis for occupational exposure protection in non-medical radiation work units and better protect the occupational health rights and interests of radiation workers. Methods A questionnaire survey was conducted to investigate some non-medical institutions in Shanxi Province. On-site testing was carried out to determine the risk factors for radioactive occupational diseases in the selected non-medical institutions. Results In 220 non-medical institutions, there were 340 radiation devices and 2284 radioactive sources. The rate of individual dose monitoring was 92.7% and the rate of occupational health examination was 87.2%. These devices were equipped with 325 detection instruments for radiation protection, 1316 personal protective equipment, and 730 personal dose alarms. Radiation occupational disease risk factors were investigated in 101 institutions. Conclusion The occupational health management of radiation workers in non-medical institutions in Shanxi Province is generally in line with the national standards. However, there is still a big gap with the level of occupational health management in medical institutions. The health administration departments should clarify the management measures for non-medical institutions and strengthen their supervision and management functions.

Análise de instrumento orientador: contribuições para a simulação realística em saúde / Guiding instrument analysis: contributions to realística simulation in healthcare / Análisis de instrumentos rectores: contribuciones a la simulación realista en salud

Objetivo: analisar um instrumento orientador para a Simulação Realística em Saúde utilizado por uma Instituição de Ensino Superior. Método: estudo descritivo, qualitativo com participação de 23 profissionais com Graduação na área da saúde e experiência em simulação realística. A coleta de dados, via questionário on-line, ocorreu no período de março a junho de 2020. Utilizou-se a análise de conteúdo temático-categorial. Resultados: o instrumento contempla as etapas necessárias para o cotidiano do ensino em simulação. A categoria "Itens imprescindíveis para o planejamento da simulação" engloba.: preparo do cenário simulado; atuação dos docentes/facilitadores no briefing e no desenvolvimento do cenário simulado; atuação dos docentes/facilitadores no debriefing; e avaliação da simulação. Conclusão: o desenvolvimento desta pesquisa possibilitou adequação das dimensões do Isimula favorecendo clareza às etapas necessárias à simulação e contribui para apoiar docentes/facilitadores no planejamento, desenvolvimento e avaliação da simulação, em diferentes contextos de atenção à saúde.

Objective: to analyze a guiding instrument for Realistic Simulation in Health used by a Higher Education Institution. Method: this was a descriptive, qualitative study involving 23 professionals with a degree in healthcare and experience in realistic simulation. Data was collected via an online questionnaire between March and June 2020. Thematic-categorical content analysis was used. Results: the instrument covers the necessary steps for day-to-day simulation teaching. The category "Essential items for planning the simulation" includes: preparing the simulated scenario; the role of teachers/facilitators in briefing and developing the simulated scenario; the role of teachers/facilitators in debriefing; and evaluating the simulation. Conclusion: the development of this research enabled the dimensions of Isimula to be adapted, favoring clarity in the stages necessary for simulation and helping to support teachers/facilitators in the planning, development and evaluation of simulation in different healthcare contexts.

Objetivos:analizar un instrumento de orientación para la Simulación Realista en Salud utilizado por una Institución de Enseñanza Superior. Método: estudio descriptivo y cualitativo en el que participaron 23 profesionales con titulación sanitaria y experiencia en simulación realista. Los datos se recogieron a través de un cuestionario online entre marzo y junio de 2020. Se utilizó análisis de contenido temático-categorial. Resultados: el instrumento recoge los pasos necesarios para el día a día de la enseñanza de la simulación. La categoría "Elementos esenciales para la planificación de la simulación" incluye: la preparación del escenario simulado; el papel de los profesores/facilitadores en la información y el desarrollo del escenario simulado; el papel de los profesores/facilitadores en el debriefing; y la evaluación de la simulación. Conclusión: el desarrollo de esta investigación permitió adaptar las dimensiones de Isimula, favoreciendo la claridad en las etapas necesarias para la simulación y ayudando a apoyar a los profesores/facilitadores en la planificación, desarrollo y evaluación de la simulación en diferentes contextos sanitarios.

Variação glicêmica em idosos diabéticos com COVID-19 / Glycemic variation in elderly diabetic patients with COVID-19

Este estudo teve como objetivo identificar a variação glicêmica de idosos com diabetes mellitus e COVID-19 em instituições de longa permanência. Foram coletados e analisados prontuários e resultados de exames laboratoriais de 203 idosos residentes em 4 ILPIs no município de Maringá, pertinentes ao período entre 2017 e 2022. Destes, 10 idosos apresentavam diagnóstico de diabetes mellitus, sendo selecionados os 5 que apresentaram diagnóstico de COVID-19 e exames de glicemia detalhada durante o período estudado. Três deles apresentaram aumento na glicemia, enquanto os outros dois praticamente mantiveram os mesmos índices glicêmicos pré e pós-COVID-19. Todos os casos apresentaram manifestações leves da COVID-19 sem necessidade de internação. Os resultados indicam que idosos com índices glicêmicos elevados para a sua respectiva idade podem apresentar índices de elevação da glicêmica quando infectados pelo SARS-CoV-2.

This study aimed to identify the glycemic variation in the elderly with diabetes mellitus and COVID-19 in long stay institutions. Medical records and laboratory test results from 203 elderly residents of 4 LSIE in the municipality of Maringá, pertaining to the period between 2017 and 2022. Of these, 10 were diagnosed with diabetes mellitus, being selected the 5 who were diagnosed with Covid-19 and that had detailed glycemic lab test results from the period in question. Three of them showed glycemic increase, while the other two practically maintained the same glycemic indices before and after Covid-19. All cases had light manifestations of Covid-19, without the need for hospitalization. The results indicate that elderly people with glycemic indices above the normal established for their age may have increased blood glucose when infected with SARS-CoV-2.

Manejo das urgências subjetivas nas instituições: que lugar para o serviço-escola? / Maneuvering subjective urgency in institutions: what is the role of psychology school-service? / ¿Manejo de las urgencias subjetivas en las instituiciones: que lugar para el servicio-escuela?

Neste artigo pretende-se discutir a problemática do manejo da urgência subjetiva nas instituições, apoiando-se em uma investigação em andamento no serviço-escola de uma universidade pública. Interroga-se a urgência generalizada, marca de nossos tempos, para situar as coordenadas do manejo da angústia presente nas demandas por assistência em saúde mental dirigidas às instituições. Articula-se, a partir das referências teórico-clínicas dentro da psicanálise de orientação lacaniana, a prática do manejo das urgências em diversos dispositivos de saúde. Pretende-se circunscrever a partir dessa elaboração, o duplo pertencimento dos serviços-escola: lugar de formação e instituição que, de alguma forma, participa da rede de saúde mental. (AU)

This article intends to discuss the problem of maneuvering subjective urgency in institutions, based on ongoing research in development at the school-service of a public university. The widespread urgency is questioned, as a mark of our time, to locate thecoordinates of the management of anxiety present in demands for mental health assistance directed at institutions. It is articulated, through theoretical-clinical references within lacanian oriented psychoanalysis, the practical maneuvering of urgencies in several health devices. It is intended to circumscribe through this elaboration, the double belonging of school-services: place of formation and institution that, in some way, participates in the mental health network. (AU)

En este artículo se pretende discernir la problemática del manejo de la urgencia subjetiva en las instituciones, a partir de una investigación en desarrollo en el servicio-escuela de una universidad pública. Se interroga la urgencia generalizada, marca de nuestra época, para situar las coordinadas del manejo de la angustia presente en las demandas por asistencia en salud mental dirigidas a las instituciones. Desde las referencias teórico-clínicas se articula la práctica del manejo de las urgencias en diversos servicios de salud. Se pretende, a partir de esa discusión, circunscribir la doble pertenencia de los servicios-escuela: lugar de formación que, de alguna forma, participa de la redde salud mental. (AU)

Congresso de Psicanálise da Banana: Evidências Inaugurais da Discriminação na Política Institucional Lacaniana / Banana Psychoanalysis Congress: Inaugural Evidence of Discrimination in Lacanian Institutional Policy / Congreso de Psicoanálisis de Plátano: Evidencias Inaugurales de la Discriminación en la Política Institucional Lacaniana

Abordou-se a chegada do pensamento lacaniano ao Brasil e a sua divulgação no Congresso Psicanalítico da Banana, marco inaugural no qual se encontra uma expressão nacional da reprodução dos impasses político-institucionais nas escolas lacanianas. Procedeu-se a uma busca no sítio da hemeroteca digital da Fundação Biblioteca Nacional utilizando como descritores o nome do evento e/ou o nome de seus organizadores no período de fevereiro de 1980 a dezembro de 1989. Utilizou-se como referência do trabalho a perspectiva da Escola dos Annales,que considera que a escrita histórica deve se orientar por problemas específicos; a consideração da transferência como marca indelével da pesquisa realizada por psicanalistas pesquisadores; as reflexões de Ricouer sobre as etapas da construção do conhecimento historiográfico. As matérias publicadas apresentam de forma recorrente: as celeumas entre os psicanalistas lacanianos e os filiados à IPA; a busca de reconhecimento dos analistas lacanianos brasileiros pelos franceses; a proposta de discussão da conjuntura nacional por meio da psicanálise; a divergência entre analistas lacanianos brasileiros acerca da tutoria francesa nas instituições surgidas no Brasil. Propôs-se a consideração da dimensão transferencial como possibilidade de construção de uma política emancipatória nas instituições psicanalíticas.

This discussion is about the arrival of Lacanian thinking in Brazil and its dissemination at the Banana Psychoanalytic Congress, an inaugural milestone in which a national expression of the reproduction of political-institutional impasses in Lacanian schools can be found. A search was carried out on the website of the digital newspaper library of the National Library Foundation using as descriptors the name of the event and/or the name of its organizers, from February 1980 to December 1989. What was used as a reference for the work was the perspective of the Annales School which considers that historical writing must be guided by specific problems; the consideration of the transference as an indelible mark of research carried out by researchers of the psychoanalytic field; Ricouer's reflections upon the stages of the construction of the historiographical knowledge. The published articles present recurrently: the controversy between Lacanian psychoanalysts and those affiliated with the IPA; the search for recognition of Brazilian Lacanian analysts by the French; the proposal to discuss the national situation through psychoanalysis; the divergence between Brazilian Lacanian analysts about French tutoring in institutions that emerged in Brazil. It was proposed to consider the transferential dimension as a possibility of building an emancipatory policy in psychoanalytic institutions.

Se ha discutido la llegada del pensamiento lacaniano en Brasil y su difusión en el Congreso Psicoanalítico de Plátano, hito inaugural en el que se encuentra una expresión nacional de los impases político-institucionales en las escuelas lacanianas. Se realizó una búsqueda en la hemeroteca digital de la Fundación Biblioteca Nacional utilizando como descriptores el nombre del evento y/o el nombre de sus organizadores, en el período de febrero de 1980 hasta diciembre de 1989. Se utilizó como referente para el trabajo la perspectiva de la Escuela de los Annales, que considera que la escritura histórica debe guiarse por problemas específicos; la consideración de la transferencia como una marca de la investigación realizada por los psicoanalistas; las reflexiones de Ricouer sobre las etapas de la construcción del conocimiento historiográfico. Los artículos publicados presentan de manera recurrente: la controversia entre los lacanianos y los afiliados a la IPA; la búsqueda del reconocimiento de los lacanianos brasileños por parte de los franceses; la propuesta de discutir la situación nacional a través del psicoanálisis; la divergencia entre lacanianos brasileños sobre la tutoría de francés en instituciones surgidas en Brasil. Se propuso considerar la dimensión transferencial como posibilidad de construcción de una política emancipatoria en estas instituciones.

Avaliação das Instituições de Longa Permanência para Idosos no Brasil: um panorama das desigualdades regionais / Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Resumo O objetivo deste artigo é avaliar as Instituições de Longa Permanência para Idosos (ILPI) brasileiras, segundo o Modelo Teórico Multidimensional Integrado de Qualidade e Atendimento (MIQA), e comparar o desempenho alcançado entre as regiões do país. Estudo ecológico descritivo realizado com dados secundários públicos das ILPI participantes do Censo do Sistema Único da Assistência Social de 2018. Uma Matriz de Avaliação foi construída a partir das variáveis do Censo e do Modelo Teórico MIQA. Parâmetros de qualidade foram empregados para classificar o desempenho das instituições para cada indicador em "incipiente", "em desenvolvimento" ou "desejável. O índice de disparidade foi obtido para cada indicador. Foram analisadas 1.665 instituições. Observaram-se diferenças nos percentuais de ILPI com desempenho "desejável" entre as regiões brasileiras, e a necessidade de aprimoramento na maioria das ILPI em relação à proporção de cuidadores de pessoas idosas, a composição da equipe multiprofissional, a acessibilidade e a oferta de ações de promoção de saúde. Verificou-se a necessidade de apoio governamental para a supressão dos critérios de diferenciações excludentes e para a expansão dos serviços para superar as superlotações.

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions' performance for each indicator as "incipient", "developing" or "desirable". The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with "desirable" performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

Evaluación económica de las instituciones de salud basado en el análisis de los costos de los servicios

La calidad de los servicios constituye una prioridad en cualquiera de los sectores o empresas que tenga como finalidad prestar un servicio o un bien, independientemente del tipo que sea. La calidad de los servicios brindado depende de varios factores, pero, sin duda alguna, la evaluación de costos constituye un factor fundamental en la evaluación económica de las empresas, especialmente en instituciones de salud. El objetivo de esta investigación fue analizar la influencia que puede ejercer el estudio de los costos de los servicios en la evaluación económica de las instituciones de salud. Para esto se realizó un análisis de los elementos generales de la evaluación económica y específicos de su aplicación en instituciones de salud; con énfasis en el análisis de costos de servicios. Los resultados muestran que los costos determinan varios elementos relacionados con la calidad de los servicios prestados, de ahí que se concluya que un eslabón importante en la evaluación económica de las instituciones de salud lo constituye el análisis de los costos; ya qua a partir de ellos se pueden identificar brechas y puntos vulnerables que con acciones directas puedan ser solucionados parcial o totalmente; a partir de ellos se puede mejorar la calidad del servicio prestado.

The quality of the services constitutes a priority in any of the sectors or companies whose purpose is to provide a service or a good, regardless of the type it is. The quality of the services provided depends on several factors, but, without a doubt, the evaluation of costs constitutes a fundamental factor in the economic evaluation of companies, especially in health institutions. The objective of this research was to analyze the influence that the study of the costs of services can exert on the economic evaluation of health institutions. For this, an analysis of the general elements of economic evaluation and specifics of its application in health institutions was carried out; with emphasis on service cost analysis. The results show that costs determine various elements related to the quality of the services provided, hence it is concluded that an important link in the economic evaluation of health institutions is cost analysis; since from them it is possible to identify gaps and vulnerable points that with direct actions can be partially or totally solved; from them the quality of the service provided can be improved.

Thinking on Clinical Key Problems During Transformation of Preparations in Medical Institutions to Innovative Chinese Medicines / 中国实验方剂学杂志

Under the national policy background of traditional Chinese medicine（TCM）registration review and approval reform， TCM preparations in medical institutions（hereinafter referred to as medical institution preparations） have human use experience， conform to the characteristics of TCM clinical practice， and have advantages in the research and development of innovative Chinese medicines. Therefore， the research and development mode based on clinical experience prescription-medical institution preparations-innovative Chinese medicines has attracted widespread attention from the industry. However， in the process of development and use of medical institution preparations， there are generally clinical problems that restrict their transformation into innovative Chinese medicines， resulting in a relatively weak collection basis of human use experience and insufficient clinical evidence for supporting the research and development of new TCM medicines. In this paper， on the basis of sorting out the supporting regulations and relevant technical requirements of human use experience， and analyzing the clinical problems restricting the transformation of medical institution preparations， it provides suggestions for medical institutions to carry out high-quality research on human use experience of preparations in the process of TCM clinical practice from the aspects of continuously exploring clinical value， improving the construction of information system， focusing on the TCM clinical practice and giving full play to the advantages of discipline cooperation. By realizing the whole life cycle management of medical institution preparations based on three-combination evaluation evidence system， we can promote the transformation of medical institution preparations into innovative Chinese medicines.

Characteristics of whole blood donors from 26 blood stations before and after the outbreak of COVID-19:a multicenter study / 中国输血杂志

【Objective】 To analyze the basic characteristics of whole blood donors from blood stations before and after the outbreak of COVID-19. 【Methods】 After excluding invalid data, data related to the basic characteristics of whole blood donors collected from 26 blood stations in China during 2018 to 2021 were statistically analyzed, including the trend of total whole blood donors, the number of repeated blood donors, the frequency of blood donation, the average age of donors and the recruitment of first-time blood donors. 【Results】 Affected by the epidemic, 8 out of 14 indicators were with large variations, accounting for 57%. The overall growth rate of total whole blood donors during the epidemic was higher than before the epidemic (P<0.05).The number of repeated blood donors has shown an increased trend, with a higher number during the epidemic than before (P<0.05). The frequency of blood donation was lower during the epidemic than before(P<0.05).Average ages of blood donors and female blood donors fluctuated widely during the epidemic, both higher than those before the epidemic(P<0.05).The donation rate of first-time blood donors <25 years old and ≥25 years old varied widely and irregularly during the epidemic (both P<0.05). The percentage of first-time blood donors fluctuated irregularly during the epidemic, with overall percentage lower than that before the epidemic(P<0.05). 【Conclusion】 Whole blood donors from 26 blood stations increased after the outbreak of COVID-19, and some indicators in certain areas showed significant fluctuations during the epidemic.

Capacitation of essential school workers in compliance with Philippine COVID-19 guidelines:A qualitative study

Introduction@#Organizations, including higher education institutions (HEIs), have been mandated to protect employees from the threats of the COVID-19.@*Objective@#This study sought to describe the perceptions of essential school workers (ESWs) of selected HEIs in the southern Manila area in terms of how they were capacitated in compliance with national guidelines.@*Methods@#A total of seven HEIs participated in this qualitative study. Focus group discussions (FGDs) were conducted among four sectors of ESWs: security, maintenance, health services, and office staff. Thematic analysis was used to draw insights from the narratives of the FGDs.@*Results@#Three themes emerged from the FGDs: material capacitation, programmatic capacitation, and issues and challenges.@*Conclusion@#This study highlights that from the perspective of ESWs, HEIs in the southern Manila area exert efforts to comply with IATF guidelines through various expressions of material and programmatic capacitation to protect them from the threat of COVID-19. However, results also demonstrate challenges that deter full compliance and consistent implementation of the guidelines across institutions.

Analysis and enlightenment of drug-related administrative penalty cases in medical institutions from 2020 to 2022 / 中国药房

OBJECTIVE To analyze the patterns and characteristics of drug-related administrative penalty cases with medical institutions as parties from 2020 to 2022 in order to further improve drug management in medical institutions. METHODS A retrospective statistical analysis was used to summarize the drug-related administrative penalty decisions with medical institutions as parties， and to match them with the provisions of the Drug Administration Law （2019 version） for statistical analysis. RESULTS There were 144 complete administrative penalty decisions with medical institutions as parties. Analyzed by cause， 126 cases of administrative punishment for inferior drugs accounted for 87.50%， of which expired drugs accounted for more than 50.00% of the inferior drug cases； 15 cases （10.42%） were for purchasing drugs from enterprises or individuals not qualified to operate drugs. Analyzed by the range of punishment amount of the cases， 34 cases （23.61%） resulted in lighter penalties， while 81 cases （56.25%） resulted in reduced penalties. CONCLUSIONS There are extremely few medical institutions that have received administrative penalties for drug management violations. Medical institutions should strengthen the awareness of law-abiding， and know the red line of drug management and the illegal behavior that is easy to occur， so as to better strengthen drug quality management.

Review and comment rules of national key monitoring drug prescriptions （medical orders） / 中国药房

In order to standardize the review and comment of national key monitoring drug prescriptions （medical orders） by medical institutions at all levels， the Sichuan Academy of Medical Sciences·Sichuan Provincial People’s Hospital took the lead in compiling the Review and Comment Rules of National Key Monitoring Drugs prescriptions （Medical Orders） herein after referred to as the Rules in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as the List） issued by the National Health Commission confirmed in Jan. 13， 2023. According to the laws and drug instructions issued by the national drug regulatory department， clinical guidelines and expert consensus， combined with the actual situation of patients （including age， body weight， liver and kidney function）， the writing group classified the common and unreasonable drug use problems for 30 kinds of drugs included in the List and develop the review and comment details. After two rounds of Delphi method questionnaire research and experts’ online meetings， and reviewed by the steering committee， the final Rules was formed. The Rules aim to provide reference for the evaluation of the rational use of drugs included in the List by medical institutions， so as to realize the standardized management of key monitoring drugs， promote the rational drug use in medical institutions， and ensure the safety of drug use for patients.

Principles for the rational use of national key monitoring drugs （the second batch） / 中国药房

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

Analysis of labor relationship in the diagnosis of occupational diseases / 中国职业医学

Unclear labor relationship is the most common challenging issue in occupational disease diagnosis. At present, there are three main errors in the understanding regarding labor relationship in the process of occupational disease diagnosis. Firstly, labor relationship does not need to be considered in occupational disease diagnosis. Secondly, labor relationship must exist in order to initiate the occupational disease diagnosis procedure. Lastly, there is an overreach in handling labor relationship issues beyond one's authority. Labor relationship is the basic and antecedent problem which cannot be avoided in occupational diseases diagnosis. While officially, labor relationship issue should be considered in occupational disease diagnosis, they are not a necessary condition. The occupational diseases diagnosis requires actual labor and employment relations. If the workers with actual labor-relation are suspected to have health injuries caused by occupational hazards in the workplace, they are eligible for occupational diseases diagnosis. But it is not the responsibility of health department to judge the labor relationship. When a dispute arises between a worker and an employer regarding labor relationship, the resolution of the relevant dispute shall be submitted to the human resources and social services department or the labor and personnel arbitration committee, or submitted to the court for adjudication according to law. In the process of occupational disease diagnosis, the two reasonable disposal procedures for verifying actual labor and employment relationship involve workers submitting evidence of their labor relationship with the employer, and the employer's verification. If the employer disputes the labor relationship as presented by the worker, the occupational disease diagnosis institution should inform the worker to apply for labor dispute arbitration. However, it is important to note that arbitration or mediation documents from the court cannot be used as evidence in occupational disease diagnosis.

Research on the allocation efficiency of primary medical and health institutions in China based on data envelopment analysis / 中华医院管理杂志

Objective:To analyze the input and output status of health resources in primary medical and health institutions and their allocation efficiency in different regions of China, and to provide an empirical basis for optimizing the allocation of primary medical and health resources in China among regions.Methods:The input index data (number of beds and number of health personnel) and output index data (number of primary medical and health institutions visits, number of family health services, number of hospital admissions) of primary medical and health institutions in China in 2020 were extracted from the China Health Statistical Yearbook 2021. Based on the BCC ( Banker, Charnes, Cooper) model of data envelopment analysis ( DEA), the Bootstrap- DEA method was used to correct bias, the allocation efficiency of primary medical and health resources in 31 provinces was calculated and the regional differences were analyzed. Results:After bias correction, the technical efficiency (TE) of resource allocation in primary medical and health institutions decreased by 0.102. The average TE score of all 31 primary medical and health institutions was 0.669, indicating a serious problem of ineffective use of technology. The TE of the eastern, central and western regions was 0.694, 0.663, and 0.649 respectively. There was obvious polarization in the central regions.Further analysis of the efficiency improvement of non DEA efficient provinces showed that 2 DEA weakly efficient provinces and 16 DEA ineffective provinces had several reference provinces for efficiency configuration improvement; The provinces that have been referenced more than 10 times were Zhejiang, Chongqing, Sichuan, and Ningxia, while the provinces that were listed as the first reference by other provinces were Ningxia, Chongqing, Zhejiang, and Tibet.Conclusions:The resource allocation efficiency of primary medical and health institutions in China is relatively low, and regional differences are obvious. The balance between different inputs and outputs should be considered when allocating the resources. Non DEA effective provinces can use DEA analysis to find the most suitable reference object and make reference improvements in the short term.

Current situation and policy suggestions of medical social work supervision in shanghai / 中华医院管理杂志

Objective:To investigate the current situation of medical social worker supervision in Shanghai, for reference to promote the high-quality development of medical social work.Methods:From June to July 2022, a questionnaire survey was conducted on the in-service medical social workers in all medical institutions with medical social work departments or posts in Shanghai. The questionnaire mainly included demographic information, current status of supervision implementation, and effectiveness of supervision. The data were analyzed descriptively with t test for comparison between groups and the Pearson test was for correlation analysis. Results:A total of 99 medical social workers were included in this study, 65 had received supervision, and medical institutions where 58 people located had established the supervision system. The average scores of actual and expected supervisory support received by medical social workers were 3.71 and 4.20 respectively, and the mean burnout level score was 32.91. The effect of establishing a supervision institutions on burnout was statistically significant ( P<0.05) and actual access to supervision support was negatively associated with burnout ( P<0.05). Conclusions:The overall situation of medical social work supervision in Shanghai was positive, but the demand for supervision was not fully satisfied; Supervision had a positive impact on reducing the burnout level. It is suggested that medical social work should further strengthen the cultivation of supervisory talents, promote the construction of supervisory systems, and improve the quality of supervision.

Analysis of the current performance of pharmacy outpatient services at grassroots medical institutions at home and abroad / 中华医院管理杂志

Pharmacy services in grassroots medical institutions provide professional pharmacy services for patients. This service not only expanded the scope of primary care delivery, but also meets the residents′need for appropriate medication. At present, the majority of grassroots medical institutions in China provide outpatient pharmacy services by means of pharmacy service alliance, and foreign grassroots medical institutions mainly provide pharmaceutical outpatient services with drug treatment management as the core for patients by granting pharmacists partial prescription rights.In recent years, pharmaceutical outpatient services in grassroots medical institutions had achieved good results in improving patient clinical outcomes, enhancing medication rationality, and enhancing patient compliance. However, there were many unresolved issues, including low public awareness, shortage of pharmaceutical talents, and imperfect guarantee systems. The author suggestted that efforts should be made to increase the publicity of pharmaceutical outpatient services, improve the training mechanism for pharmacists, strengthen cooperation between pharmacists and clinical physicians, include pharmacists in the contracted service team of family doctors, and improve various guarantee systems, in order to provide reference for promoting the sustainable development of pharmaceutical outpatient services in grassroots medical institutions in China.

Analysis and suggestions on conflict of interest in the transformation of scientific and technological achievements in medical institutions / 中华医院管理杂志

In recent years, the issue of conflicts of interest in the transformation of scientific and technological achievements in medical institutions in China has become prominent, mainly manifested as personal and institutional conflicts of interest, with the characteristics of complexity and sustainability. At present, there were some problems in the conflict management of scientific and technological achievements transformation of medical institutions, such as insufficient support of relevant laws, regulations and policies, insufficient supervision of medical institutions, and the lack of industry management atmosphere. The author suggestted that government departments should strengthen the formulation of relevant policies and regulations, medical institutions should establish an interest conflict management system and an independent management department, and industry associations should give full play to their role in assisting, so as to provide reference for promoting medical institutions to effectively manage interest conflicts in the transformation of scientific and technological achievements.