Clinical comprehensive evaluation of Reyanning Mixture in treatment of acute upper respiratory tract infection (heat-toxin attacking lung syndrome) / 中国中药杂志

This study systematically sorted out the evidence data of the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine(TCM) of Reyanning Mixture in the treatment of acute upper respiratory tract infection(heat-toxin attacking lung syndrome) with the qualitative and quantitative evaluation methods adopted. Based on evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, pharmacoeconomics, and health technology evalua-tion(HTA), the clinical value of Reyanning Mixture was evaluated using multi-criteria decision analysis(MCDA) model, Chinese patent medicine clinical evidence, and value evaluation software(CSC v2.0). The SRS monitoring data, Meta-analysis, and other safety evidence showed that the main adverse reactions of Reyanning Mixture were nausea, diarrhea, and rash, and no serious adverse reactions were found. The pharmacovigilance system was sound, and the system was perfect. There was no recall, notification, or interview for unqualified products. Based on the existing research, the evidence was sufficient, and the risk was controllable. Hence, its safety was grade A. Meta-analysis showed that in the treatment of acute upper respiratory tract infection, Reyanning Mixture combined with Amoxicillin Capsules was better than Amoxicillin Capsules alone in shortening the complete fever relief time and improving the cure rate. Besides, it was superior to Shuanghuanglian Granules in shortening the complete fever relief time, cough relief time, nasal congestion relief time, and pharyngeal congestion relief time. The Meta-analysis was conducted based on AMSTAR standard, and its ove-rall quality was proved good. The evidence quality in GRADE system evaluation was medium and low. The quality of evidence was medium, and the clinical value was obvious. Hence, its effectiveness was grade A. The results of pharmacoeconomic research showed that compared with Amoxicillin Capsules, Reyanning Mixture alone or in combination with Amoxicillin Capsules had cost-effectiveness advantages in the treatment of acute upper respiratory tract infection, and the results were stable in sensitivity analysis. According to the CASP economic evaluation checklist, the research problems were clear and the results were reliable. As revealed by the comprehensive evaluation, the evidence quality was sufficient and the result was clear. Its economy was grade B. Reyanning Mixture had multiple therapeutic targets like anti-virus, anti-bacteria, antipyresis, and anti-cough, with good clinical innovation. There were many innovative initiatives in ensuring drug supply, especially at the grass roots, drug safety, and effectiveness, and also multiple innovative contributions to production technology, quality control, scientific and technological research and development, and enterprise management and marketing. Therefore, its innovation was grade B. The dosage form of Reyanning was mixture, which made it convenient for storage and transportation. The usage was easy to be mastered and accepted by doctors and nurses, exhibiting good suitability for clinicians, nurses, pharmacists, and patients who received this drug and basically meeting the needs of clinical medication. The suitability was grade B. The average daily cost of this drug was 8.082 yuan, and the price was low. The treatment cost accounted for a small proportion of the annual disposable income of urban and rural residents, indicating that it was affordable. Reyanning Mixture was available in 31 provinces, cities and autonomous regions, covering 6 910 hospitals. The allocation of hospitals at all levels was more than 50%. There was no shortage or supply restriction of medicinal material resources. The annual production capacity was sufficient to meet the supply demand, so its accessibility was grade A. Reyanning Mixture, sourced from "pneumonia Ⅲ", has been subjected to a real-world study of its clinical application, with 4 367 cases involved, and the characteristic of TCM was grade B. The comprehensive evaluation results demonstrated that the clinical value score of Reyanning Mixture in the treatment of acute upper respiratory tract infection(heat-toxin attacking lung syndrome) was 0.80, making it rated class A. According to the Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021), it is recommended to convert it into the relevant policy results of basic clinical medication management according to the procedures.

Research on KBP model refining method using multi-criterion optimization technology / 中华放射肿瘤学杂志

Objective:Utilizing multi-criterion optimization (MCO) technology to improve plan design quality based on knowledge-based planning (KBP) model.Methods:Fifty-five patients with nasopharyngeal carcinoma (NPC) who had completed radiotherapy were selected, and fixed-field intensity-modulated radiotherapy (IMRT) technology was used in each case. Among them, 40 cases were randomly selected as training set 1. Then, IMRT plans in training set 1 were preprocessed by MCO technology to construct a new training set 2. With the initial training set 1 and the processed training set 2 as training samples, the traditional KBP model and the MCO-KBP model refined by MCO technology were trained, respectively. Among the remaining 15 cases, 5 cases were randomly selected as the validation set, and the remaining 10 cases were used as the test set. After verification, the test set was used to statistically analyze the plan quality of the initial manual plan and the automatic plan generated by the traditional KBP model and the MCO-KBP model.Results:The target dose (D 95%) of plans generated by the traditional KBP model and the MCO-KBP model met the clinical requirements. Conformity index (CI) and homogeneity index (HI) were almost the same ( P>0.05), and the doses of organ at risk (OAR) of the automatic plans generated by the MCO-KBP model were lower than those of the traditional KBP model. For example, compared with the traditional KBP model, the average D max of the brainstem in the automatic plans generated by the MCO-KBP model was lower by 2.13 Gy, the average D mean of the left parotid gland was lower by 1.39 Gy, the average D mean of the right parotid gland was lower by 1.59 Gy, and the average D max of the left optic nerve was lower by 1.42 Gy, the average D max of the right optic nerve was lower by 1.16 Gy, and the average D max of the pituitary gland was lower by 1.88 Gy. All of the above-mentioned dosimetry indexes were statistically significant. Conclusion:Compared with the traditional KBP model, the IMRT plans designed by the refined MCO-KBP model have obvious advantages in the protection of OAR, which proves the feasibility of utilizing MCO technology to improve the plan design quality of the KBP model.

Optimization of extraction technology process for Honghua Tongluo Prescription by an FAHP-based evaluation model / 中草药

Objective: To establish an optimization model for the extraction technology process of Honghua Tongluo Prescription (HTP) based on fuzzy analytic hierarchy process (FAHP). Methods: The evaluation indexes tree was established which included objective level, criterion level, and index level. The criterion level consisted of effective constituent, impurity control, behavioristics, histopathology, and immune response. The index level consisted the extraction efficiency of hydroxysafflor yellow A (HSYA) and icariin, the content of total substances, mechano-allodynia, and mechano-hyperalgesia, the ratios of decentered nucleolus in dorsal root ganglion, the content of SP in pelma skin with plantar P quality as the index layer. Weighting coefficient of all the indexes was decided by FAHP based calculation. HTP extraction process route was comprehensively evaluated. Results: The importance degrees (ω) of each criterion from high to low were: immune response (ω=0.245), histopathology (ω=0.23), effective constituent, behavioristics (ω=0.20), and impurity control (ω=0.125). The optimized extraction technology process was that Carthami Flos was better extracted by warm maceration with water at 60℃, Epimedii Herba was circulated by reflux extraction with water. Cinnamomi Ramulus was better treated by reflux extraction with 80% alcohol. Conclusion: An FAHP-based evaluation method with pharmacological indexes, effective constituent indexes, and impurity control as evaluation indexes, which could put formula Chinese materia medica principle and modern pharmaceutical engineering demands into consideration, is comprehensive and effective.

Cursos de graduação em medicina: uma análise a partir do sinaes / Undergraduate medical courses in Brazil: an analysis based on the sinaes system

Estudo descritivo analítico dos indicadores do Sistema Nacional de Avaliação da Educação Superior-Sinaes/Inep/MEC. Existem evidências de problemas metodológicos nos instrumentos do Exame Nacional de Desempenho dos Estudantes (Enade). Houve variação das matrizes de referência em 2004 e 2007, mudanças nas fórmulas e multicolinearidade no cálculo do Conceito Preliminar e do nível de dificuldade das provas, respectivamente 65 por cento em 2004 e 35 por cento em 2007. Nos dois períodos, quase metade das questões avaliou a capacidade de memorização (47 por cento e 42 por cento). A análise Cart apontou condição sociocultural, rede pública de ensino e percepção de alta oferta de formação complementar pela instituição como fatores associados ao melhor desempenho do concluinte. Tanto a nota no componente específico do concluinte como a diferença entre a nota de formação geral do concluinte e do ingressante são indicadores de forte discriminação de desempenho. Propõe-se um indicador multicritério dessas duas quantidades, que foi capaz de discriminar as instituições bem conceituadas da área médica. Matrizes de referência compatíveis e robustas são necessárias para o monitoramento de cursos que formem profissionais de excelência e que estejam conscientes de suas responsabilidades sociais.

This descriptive study of the indicators from the National System for the Evaluation of Higher Education-Sinaes/Inep/MEC. There is evidence of methodological problems in the construction of the instruments for the National Examination of Students' Performance (Enade). There was a variation in the reference matrices in 2004 and 2007, changes in the formulas, and multi-colinearity in calculation of the Preliminary Classification. In 2004, 65 percent of the questions were classified as "difficult", as compared to only 35 percent in 2007..Nearly half of the questions evaluated the capacity for memorization (47 percent and 42 percent). Cart analysis pointed to the following factors associated with better performance on the graduating student's: higher socioeconomic status, public institution, and high supply of complementary training by the institution. Both the graduating student's specific component grade and the difference between them and first-year student's overall classification appear as robust performance indicators. This study proposes a multiple-criteria indicator which proved capable of discriminating between highly rated institutions in the medical field. Consistent and robust reference matrices are necessary for monitoring courses that train excellent professionals who are aware of their social responsibilities.

Desempenho tecnológico dos serviços de abastecimento de água e esgotamento sanitário em quatro municípios de Minas Gerais: uma análise comparativa / Technological performance of water supply and sanitation services in four municipalities in Minas Gerais, Brazil: a comparative analysis

Indicadores tecnológicos representam uma importante forma de avaliar a quantidade e a qualidade dos serviços de saneamento prestados à população. Com essa perspectiva, o artigo apresenta metodologia quali-quantitativa, visando à comparação do desempenho tecnológico de serviços de água e esgotos. O modelo é constituído por indicadores de desempenho que, combinados por meio de análise multicritério (modelo TOPSIS), propiciam uma hierarquização da qualidade tecnológica dos serviços. Aplica-se a metodologia aos municípios de Itabirito, Ouro Preto, Nova Lima e Vespasiano (Minas Gerais). Buscando explorar as particularidades do desempenho de cada serviço, os resultados permitem identificar diferenças tecnológicas significativas entre eles, reveladas nos aspectos de cobertura por redes, controle de perdas, qualidade da água, estações de tratamento, tarifas, entre outros.

Technological indicators are important tools for the assessment of quantity and quality of the environmental sanitation services provided for the population. From this perspective, this paper presents a quali-quantitative methodology intending to compare technological performance of water supply and sanitation services. The method consists of performance indicators that, combined trough a multicriterion model (TOPSIS), enable the hierarchization of the technological quality of services. The model is applied at the municipalities of Itabirito, Ouro Preto, Nova Lima and Vespasiano (Minas Gerais, Brazil). Exploring particularities of each service performance, the results suggest significant technological differences between the services, based on aspects of coverage, water loss control, water quality, treatment plants, tariffs, etc.