How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application.

BACKGROUND: Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services. METHODS: A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China. RESULTS: Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution. CONCLUSIONS: Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Exploring the Impact of Individual and Social Antecedents on Teachers’ Teaching Innovation: Perspective of Goal-Oriented Behavior and Social Identity

Many scholars have investigated education management. Scholars in the education field have made significant achievements in contributing to multiple educational reform policies, while other scholars discuss teacher-related issues from the perspective of organizational behavior. The teaching innovation of high school teachers plays a critical role in students’ learning attitude and motivation, especially in the context of the COVID-19 pandemic. Teachers need to utilize more diversified teaching methods to enable students to carry out effective learning. In order to examine teachers’ teaching innovation, this study explores teaching innovation intentions and performance from the perspective of individual and social factors in combination with goal-oriented behavior and social identity theory. This study conducts questionnaires with a sample of Chinese coastal high school teachers, and obtains a total of 475 responses. The research results show that innovation attitude, positive anticipated emotion, group norms and social identity positively affect teachers’ teaching innovation intention;furthermore, teachers’ teaching innovation intention also positively affects their teaching innovation performance. Based on the comprehensive research findings, this research proposes corresponding theoretical and practical implications.

Does Proton Pump Inhibitor Use Lead to a Higher Risk of Coronavirus Disease 2019 Infection and Progression to Severe Disease? a Meta-analysis.

The findings of previous research on the association between proton pump inhibitor (PPI) use and the treatment and prevention of coronavirus disease 2019 (COVID-19) are inconsistent. Therefore, this meta-analysis was conducted to clarify the outcomes of patients taking PPIs. This analysis included 14 articles with more than 268,683 subjects. PPI use was not associated with increased or decreased risk of COVID-19 infection (odds ratio [OR] 1.64, 95% confidence interval [CI] = 0.54-5.00, P = 0.39) or mortality (OR = 1.91, 95% CI = 0.86-4.24, P = 0.11). However, PPI use increased the risks of severe disease (OR 1.67, 95% CI = 1.37-2.02, P < 0.00001) and secondary infection (OR 4.62, 95% CI = 2.55-8.39, P < 0.00001). In summary, PPI use was not associated with an increased risk of infection and mortality in COVID-19 but appeared to be associated with an increased risk of progression to severe disease and secondary infection. However, more original studies are urgently needed to further clarify the relationship between PPI use and COVID-19.

Evaluation Index System of Surgical Tourism Service Organizations in China: An Empirical Research (preprint)

Background: Healthcare tourism is an emerging economy with the most potential in China's health industry before the COVID-19 pandemic. Surgical medical health tourism accounts for a large part of medical tourism services in China, which has higher requirements for quality and safety. By contrast, measurement tools and theoretical research are insufficient in China. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the original Donabedian’s quality model to evaluate surgical tourism services’ quality. Methods: : Literature review and focus group interview were used to generate indicators for surgical tourism services’ quality. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through analytic hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. Validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. Reliability of the questionnaire was assessed by a pretest distributed within an international medical department of a public hospital in China. Results: : Based on the Donabedian’s quality theory, the novel evaluation system of surgical tourism service institutions with 3 dimensions, 9 first-level items and 39 second-level items was constructed. The three dimensions consist of structure (0.315), process (0.287), and outcome (0.398), with each dimension set several indicators and each indicator given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p<0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could obtain a rating of two stars. Conclusions: : The established evaluation system identified three different dimensions of surgical tourism services’ quality which fit for practical healthcare improvement in safety and quality. It can reflect the access criterion of surgical tourism institutions, provide references on better choices of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services to international standards.

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: During the current Coronavirus Disease 2019 (COVID-19) pandemic, patients with diabetes face disproportionately more. This study was performed to clarify anti-inflammatory effects of anti-diabetic agents on COVID-19 in patients with diabetes. METHODS AND RESULTS: Relevant literature was searched on 15 databases up to November 14, 2020 and was updated on April 13, 2021. The pooled ORs along with 95% CIs were calculated to evaluate combined effects. 31 studies with 66,914 patients were included in qualitative and quantitative synthesis. Meta-analysis showed that metformin was associated with a statistically significant lower mortality (pooled OR = 0.62, 95% CI, 0.50-0.76, p = 0.000) and poor composite outcomes (pooled OR = 0.83, 95% CI, 0.71-0.97, p = 0.022) in diabetic patients with COVID-19. Significance of slight lower mortality remained in sulfonylurea/glinides (pooled OR = 0.93, 95% CI, 0.89-0.98, p = 0.004), but of poor composite outcomes was not (pooled OR = 1.48, 95% CI, 0.61-3.60, p = 0.384). Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were associated with statistically non-significant lower mortality (pooled OR = 0.95, 95% CI, 0.72-1.26, p = 0.739) or poor composite outcomes (pooled OR = 1.27, 95% CI, 0.91-1.77, p = 0.162) of COVID-19 in diabetic patients. CONCLUSION: Metformin might be beneficial in decreasing mortality and poor composite outcomes in diabetic patients infected with SARS-CoV-2. DPP-4 inhibitors, sulfonylurea/glinides, SGLT-2 inhibitors, and GLP-1RA would not seem to be adverse. There was insufficient evidence to conclude effects of other anti-diabetic agents. Limited by retrospective characteristics, with relative weak capability to verify causality, more prospective studies, especially RCTs are needed. REGISTRATION NUMBER: PROSPERO-CRD42020221951.

Does Famotidine Reduce the Risk of Progression to Severe Disease, Death, and Intubation for COVID-19 Patients? A Systemic Review and Meta-Analysis.

BACKGROUND: Famotidine was reported to potentially provide benefits to Coronavirus Disease 2019 (COVID-19) patients. However, it remains controversial whether it is effective in treating COVID-19. AIMS: This study aimed to explore whether famotidine use is associated with reduced risk of the severity, death, and intubation for COVID-19 patients. METHODS: This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42020213536). A comprehensive search was performed to identify relevant studies up to October 2020. I-squared statistic and Q-test were utilized to assess the heterogeneity. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated through the random effects or fixed effects model according to the heterogeneity. Subgroup analyses, sensitivity analysis, and publication bias assessment were also conducted. RESULTS: Five studies including 36,635 subjects were included. We found that famotidine use was associated with a statistically non-significant reduced risk of progression to severe disease, death, and intubation for Coronavirus Disease 2019 (COVID-19) patients (pooled RR was 0.82, 95% CI = 0.52-1.30, P = 0.40). CONCLUSION: Famotidine has no significant protective effect in reducing the risk of developing serious illness, death, and intubation for COVID-19 patients. More original studies are needed to further clarify whether it is associated with reduced risk of the severity, death, and intubation for COVID-19 patients.

Multi-chain Fudan-CCDC model for COVID-19-a revisit to Singapore's case.

BACKGROUND: COVID-19 has been impacting on the whole world critically and constantly since late December 2019. Rapidly increasing infections has raised intense worldwide attention. How to model the evolution of COVID-19 effectively and efficiently is of great significance for prevention and control. METHODS: We propose the multi-chain Fudan-CCDC model based on the original single-chain model in [Shao et al. 2020] to describe the evolution of COVID-19 in Singapore. Multi-chains can be considered as the superposition of several single chains with different characteristics. We identify the parameters of models by minimizing the penalty function. RESULTS: The numerical simulation results exhibit the multi-chain model performs well on data fitting. Though unsteady the increments are, they could still fall within the range of _30% fluctuation from simulation results. CONCLUSION: The multi-chain Fudan-CCDC model provides an effective way to early detect the appearance of imported infectors and super spreaders and forecast a second outbreak. It can also explain the data from those countries where the single-chain model shows deviation from the data.

Dynamic models for Coronavirus Disease 2019 and data analysis.

In this letter, two time delay dynamic models, a Time Delay Dynamical-Novel Coronavirus Pneumonia (TDD-NCP) model and Fudan-Chinese Center for Disease Control and Prevention (CCDC) model, are introduced to track the data of Coronavirus Disease 2019 (COVID-19). The TDD-NCP model was developed recently by Chengars group in Fudan and Shanghai University of Finance and Economics (SUFE). The TDD-NCP model introduced the time delay process into the differential equations to describe the latent period of the epidemic. The Fudan-CDCC model was established when Wenbin Chen suggested to determine the kernel functions in the TDD-NCP model by the public data from CDCC. By the public data of the cumulative confirmed cases in different regions in China and different countries, these models can clearly illustrate that the containment of the epidemic highly depends on early and effective isolations.