[Construction of an evaluation index system for the capability of comprehensive control of mountain - type zoonotic visceral leishmaniasis based on the One Health concept].

OBJECTIVE: To construct an evaluation index system for the capability of comprehensive control of mountain-type zoonotic visceral leishmaniasis based on the One Health concept, so as to provide insights into the control and elimination of mountain-type zoonotic visceral leishmaniasis using the One Health approach. METHODS: A preliminary evaluation index system was constructed based on literature review, panel discussions and field surveys. Thirty-three experts were selected from 7 provincial disease control and prevention centers in Beijing Municipality, Hebei Province, Shanxi Province, Henan Province, Sichuan Province, Shaanxi Province and Gansu Province where mountain-type zoonotic visceral leishmaniasis was endemic, and two rounds of expert consultations were conducted to screen the indicators. The positive coefficient, degree of concentration, degree of coordination, and authority of the experts were calculated, and the normalized weights of each index were calculated with the analytic hierarchy process. RESULTS: The response rates of questionnaires during two rounds of expert consultation were both 100.00% (33/33), and the authority coefficients of the experts were 0.86 and 0.88, respectively. The coefficients of coordination among experts on the rationality, importance, and operability of the indicators were 0.392, 0.437, 0.258, and 0.364, 0.335, 0.263, respectively (all P values < 0.05). Following screening, the final evaluation index system included 3 primary indicators, 17 secondary indicators, and 50 tertiary indicators. The normalized weights of primary indicators "external environment", "internal support" and "comprehensive control" were 16.98%, 38.73% and 44.29%, respectively. Among the secondary indicators of the primary indicator "external environment", the highest weight was seen for natural environment (66.67%), and among the secondary indicators of the primary indicator "internal support", the lowest weight was seen for the scientific research for visceral leishmaniasis control (8.26%), while other indicators had weights of 12.42% to 13.38%. Among the secondary indicators of the primary indicator "comprehensive control", the weight was 16.67% for each indicator. CONCLUSIONS: An evaluation index system has been constructed for the capability of comprehensive control of mountain-type zoonotic visceral leishmaniasis based on the One Health concept. In addition to assessment of the effect of conventional mountain-type zoonotic visceral leishmaniasis control measures, this index system integrates the importance of top-level design, organizational management, and implementation of control measures, and includes indicators related to multi-sectoral cooperation.

[Construction of the Framework of a Prediagnostic Risk Assessment System for Outpatient Dental Care]. / å£è ”é—¨è¯Šè¯Šå‰é£Žé™©è¯„ä¼°ä½“ç³»æ¡†æž¶æž„å»ºçš„æŽ¢ç©¶.

Objective: To establish the framework of a prediagnostic risk assessment system for outpatient dental care and to provide references for ensuring patient safety and improving the quality of medical services. Methods: A total of 15 medical workers in a tertiary-care stomatology hospital in Sichuan Province were selected for qualitative interviews between October 2019 and December 2019. On the basis of the results of literature analysis and the interviews, an expert consultation form for prediagnostic risk assessment system for outpatient dental care was developed. Then, consultation of 10 experts in the field of oral health care and nursing was conducted between June 2020 and December 2020. Eventually, the framework of prediagnostic risk assessment system for outpatient dental care was formulated. Results: Four themes emerged from the qualitative interviews. Firstly, prediagnostic risks of dental outpatients involved mainly syncope, cardiovascular emergencies, and other emergency medical risks. Secondly, medical risks came from three sources, patients, healthcare professionals, and the environment. Thirdly, medical professionals of outpatient dental care had limited awareness of the prediagnostic medical risks of patient. Fourthly, medical professionals of outpatient dental care showed inadequate response to and management of the prediagnostic medical risks of patient. The expert consultation helped finalize the Dental Outpatient Prediagnostic Risk Assessment Questionnaire, which included 3 primary indicators (namely, general information, medical history [including history of allergy], and medication assessment), 12 secondary indicators (including patient demographics, patients' status upon admission, oral hygiene habits and special lifestyle habits, sensory disorders, special periods for female patients [ie, menstruation, pregnancy, and breastfeeding], allergy history [history of oral treatment-related allergies], past/present medical history, types of medication, route of medication administration, duration of medication administration, accuracy of medication administration, and adverse drug reactions), and 39 tertiary indicators. The effective recall rate of the expert consultation form was 100%, expert positivity was 100%, and the authority coefficient was 0.83. Kendall's harmony coefficient ranged from 0.808 to 0.839, which was statistically significant (P<0.001). Conclusion: The framework of prediagnosis risk assessment system for outpatient dental care is found to be scientific and specific, but its applicability still needs further validation in clinical practice.

The Use of an Iterative Strategy of Cognitive Interview and Expert Consultation to Revise the Quality of Life Scale for Patients with Aplastic Anemia (QLS-AA).

Background: Aplastic anemia is characterized by anemia, hemorrhage and infection, and is accompanied by a variety of complications and psychological burden. Therefore, the quality of life of AA patients is not optimistic. Our team is committed to developing an assessment tool for the quality of life of AA patients, and adopting an iterative strategy of cognitive interview and expert consultation to solve the challenges encountered in item revision. Purpose: We aim to use the strategy of cognitive interview and expert consultation to inform revision of the QLS-AA into a user-friendly tool with unambiguous items and improve the content validity of the scale. Methods: We used an iterative strategy of cognitive interview and expert consultation. Two rounds of cognitive interview were conducted to identify problems with item comprehension, recall and other cognitive processes. As well as, a multi-disciplinary group of expert consultation was consulted to review the rationality of item revisions. Results: In the first round of cognitive interview, 16 participants responded to 107 items. Among them, the most common problems were "clarification" and "item duplication". Based on the results of the first round of interview, an expert consultation was organized. A total of 16 amendments were put forward by the expert and 14 were adopted. In the second round of cognitive interviews, A total of 5 participants were included and 64 items were evaluated. Two items were suggested to be revised, and the remaining items were accurately understood and recognized by all participants. Couclusion: This study highlights the key issues to consider when incorporating patient perspectives into quality measurement. The revision of QLS-AA through the strategy of cognitive interview and expert consultation may provide valuable insights into the measurement of quality of life in aplastic patients. Trial Registration Number: ChiCTR2100047575.

Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Prepost Intervention Study.

BACKGROUND: Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment, and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. OBJECTIVE: We present the protocol for the pilot "IMPACT" (Implementing Action for Tobacco Smoking Cessation Treatment) study, which aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. METHODS: We are using a prepost observational design to examine the effects of an implementation intervention designed to improve mental health providers' delivery of the following four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status, (2) assessment of willingness to quit, (3) behavioral counseling, and (4) pharmacotherapy prescribing. To overcome key barriers related to providers' knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including (1) real-time and web-based training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing, including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention's effects on providers' knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers' perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers' implementation of evidence-based smoking cessation practices. RESULTS: The IMPACT study is being conducted at 5 clinic sites. More than 50 providers have been enrolled, exceeding our recruitment target. The study is ongoing. CONCLUSIONS: In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients. Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. TRIAL REGISTRATION: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44787.

Assessing the priority of human rights and mental health: the PHRAME approach.

BACKGROUND: Protecting all human rights of people with mental health conditions is globally important. However, to facilitate practical implementation of rights, it is often necessary to decide which of these rights should be given priority, especially when they conflict with each other. AIMS: The aim of the Priorities of Human Rights and Mental Health (PHRAME) project is to develop a replicable approach to establish a proposed set of high-priority human rights of people with mental health conditions, to facilitate practical decision-making and implementation of such rights. METHOD: A two-stage Delphi-style study with stakeholders was conducted to generate a list of key rights of people with mental health conditions, and rank priorities among these rights in terms of feasibility, urgency and overall importance. RESULTS: The stakeholders in this study consistently ranked three rights as top priorities: (a) the right to freedom from torture, cruel inhuman treatment and punishment; (b) the right to health and access to services/treatment; and (c) the right to protection and safety in emergency situations. CONCLUSIONS: Insights from PHRAME can support decision-making about the priority to be given to human rights, to guide practical action. This approach can also be used to assess how human rights are prioritised in different settings and by different stakeholders. This study identifies the clear need for a central voice for people with lived experience in research and implementation of decisions about the priority of human rights, ensuring that action respects the opinion of people whose rights are directly affected.

Performance evaluation index system in public hospitals: The Delphi technique in nursing.

AIMS: To establish a general performance evaluation index system for nursing managers in public hospitals of Wenzhou city. BACKGROUND: Head nurses' performance plays a critical role in the development and operation of hospitals. Owing to the lack of accuracy and defects in the current evaluation system in Mainland China, there is an urgent need to develop a systematic performance evaluation index system for nursing managers. METHODS: A systematic review of literature, two rounds of expert consultation using the Delphi techniques, and empirical analyses were performed. In this study, a total of 20 experts in nursing-related fields were invited to provide reliable comments on the evaluation system. The index system was modified twice during the Delphi consultation, followed by a questionnaire (n = 113) to test the suitability of the system created for public hospitals in Wenzhou. RESULTS: Both rounds of the consultation showed high response rates of 20 experts. A consensus of over 70% was reached for most indicators in the first round, while a 100% consensus was achieved for the modified index system in the second round. The results of the questionnaire for the modified index system were 100%, 98.23%, 100%, 96.46%, and 93.80% in terms of scientificity, public welfare, importance, measurability, and feasibility, respectively. CONCLUSION: A suitable index system with 4 first-level indicators, 10 second-level indicators, and 37 third-level indicators was generated to assess head nurses' performance in public hospitals, thereby enhancing their cohesion and competitiveness. IMPLICATIONS FOR NURSING MANAGEMENT: The modified performance evaluation index system serves as the cornerstone for the successful development of public hospitals and the provision of high-quality services for patients.

Study on post competency index system of public health professionals / 中华医学教育探索杂志

Objective:To clarify the elements of post competency of public health professionals and technical personnel, and construct a post competency index system of public health professionals and technical personnel.Methods:Referring to the Hay Group Competency Dictionary and literature review method, the post competency information elements of public health professional and technical personnel were constructed, and were revised through the expert consultation method. Unit-level stratified sampling was used, and 120 public health professionals were invited to evaluate the importance of the elements. SPSS 26.0 was used for data analysis, the continuous data were expressed in ( x ± s) mode, and Pearson was used to study the degree of correlation of each dimension. Finally, the post competency index system for public health positions was constructed by using the factor analysis method to extract the common factor as the first-level index. Results:The index system contained 7 first-level indicators (43 items), including public health practice skills, clinical practice skills, professional basic subject knowledge, personal professional accomplishment, public health authority and management ability, public health leadership, and public health methodology knowledge. Its weight coefficients (%) were 20.03, 17.48, 15.89, 15.68, 13.98, 12.82 and 4.11, respectively. The elements with the highest materiality scores were personal protection, responsibility and professionalism.Conclusion:Personal protection and other public health practical skills and personal professional qualities such as sense of responsibility and professionalism are the core elements of public health positions, and it is recommended to strengthen the training of public health professionals' public health practical skills in actual work, and pay attention to the cultivation of personal professional qualities, so as to establish a better team of public health talents.

Construction of an evaluation index system for the capability of comprehensive control of mountain - type zoonotic visceral leishmaniasis based on the One Health concept / 中国血吸虫病防治杂志

Objective To construct an evaluation index system for the capability of comprehensive control of mountain-type zoonotic visceral leishmaniasis based on the One Health concept, so as to provide insights into the control and elimination of mountain-type zoonotic visceral leishmaniasis using the One Health approach. Methods A preliminary evaluation index system was constructed based on literature review, panel discussions and field surveys. Thirty-three experts were selected from 7 provincial disease control and prevention centers in Beijing Municipality, Hebei Province, Shanxi Province, Henan Province, Sichuan Province, Shaanxi Province and Gansu Province where mountain-type zoonotic visceral leishmaniasis was endemic, and two rounds of expert consultations were conducted to screen the indicators. The positive coefficient, degree of concentration, degree of coordination, and authority of the experts were calculated, and the normalized weights of each index were calculated with the analytic hierarchy process. Results The response rates of questionnaires during two rounds of expert consultation were both 100.00% (33/33), and the authority coefficients of the experts were 0.86 and 0.88, respectively. The coefficients of coordination among experts on the rationality, importance, and operability of the indicators were 0.392, 0.437, 0.258, and 0.364, 0.335, 0.263, respectively (all P values < 0.05). Following screening, the final evaluation index system included 3 primary indicators, 17 secondary indicators, and 50 tertiary indicators. The normalized weights of primary indicators “external environment”, “internal support” and “comprehensive control” were 16.98%, 38.73% and 44.29%, respectively. Among the secondary indicators of the primary indicator “external environment”, the highest weight was seen for natural environment (66.67%), and among the secondary indicators of the primary indicator “internal support”, the lowest weight was seen for the scientific research for visceral leishmaniasis control (8.26%), while other indicators had weights of 12.42% to 13.38%. Among the secondary indicators of the primary indicator “comprehensive control”, the weight was 16.67% for each indicator. Conclusions An evaluation index system has been constructed for the capability of comprehensive control of mountain-type zoonotic visceral leishmaniasis based on the One Health concept. In addition to assessment of the effect of conventional mountain-type zoonotic visceral leishmaniasis control measures, this index system integrates the importance of top-level design, organizational management, and implementation of control measures, and includes indicators related to multi-sectoral cooperation.

Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation.

BACKGROUND: Shortage or low-quality antenatal care is a complex and "wicked" problem relying heavily on contextual, socio-cultural, environmental and intersectional aspects. We report the outcome of an expert consultation discussing solutions to improve antenatal care quality, access and delivery in low- and middle-income countries, and providing recommendations for implementation. METHODS: The social ecological model was used as an analytical lens to map and interpret discussion points and proposed solutions. In addition, a conceptual framework for maternal and neonatal health innovation based on the building blocks of the World Health Organization health system and the Tanahashi Health Systems Performance Model provided a logical overview of discussed solutions. RESULTS: Many barriers and norms continue to hinder antenatal care access. From values, beliefs, traditions, customs and norms, to poor resource allocation, there is a need of reshaping health systems in order to provide high quality, respectful maternal and childcare. The burden of poor maternal health, morbidity and mortality is concentrated among populations who are vulnerable due to gender and other types of discrimination, have financial constraints and are affected by humanitarian crises. CONCLUSIONS: In order to address maternal health issues, good quality and evidence-based services should be guaranteed. Investments in strengthening health systems, including data and surveillance systems and skilled health workforce, should be considered an essential step towards improving maternal health services.

Research on the construction of a performance appraisal index system for medical specialty alliances / 中华医院管理杂志

Objective:To build a performance appraisal index system for medical specialty alliances, as a reference for promoting the development of the alliances in a connotation-based, high quality and sustainable manner.Methods:An index system was initialized by means of policy literature review and brainstorming, which was followed by two rounds of expert consultations to finalize the index system. Each index in the system was weighted through the analytic hierarchy process.Results:A performance appraisal index system of specialist alliances so developed comprised the six level-1 indexes of organization and implementation, hierarchical healthcare, influence capacity, talent cultivation, clinical research and academic research, as well as 31 level-2 indexes. The average scoring of importance and operability of all the indexes was>3.50, while the weights of organization and implementation(0.205 3), talent cultivation(0.178 8)and clinical research indexes(0.165 1)were higher than the rest.Conclusions:The performance appraisal index system of specialty alliances proves highly reliable and scientific, serving a desirable vehicle for the leaders of the alliance to develop cross-regional development of medical specialties.

Construction of an evaluation index system for research-oriented disciplines in medical institutions / 中华医学科研管理杂志

Objective:To construct an index system for evaluating the development of research-oriented disciplines in medical institutions, and to provide a basis for guiding the superior disciplines towards international high-level disciplines.Methods:Through literature research and expert discussions, the basic framework of the research-oriented disciplines development evaluation system was established. The final version of the index system was determined using the Delphi method and expert interviews, and the weights of each index were established using the hierarchical analysis method.Results:After consultation, the framework of 5 first-class indexes, 16 second-class indexes, and 51 third-class indexes was finally constructed for the evaluation system of research-oriented discipline development, and the weights of indexes at different classes were calculated. The high-frequency terms " research mechanism construction" , " research team construction" and " representative research results" extracted from the expert interviews echoed the results of the weighting calculation.Conclusions:The evaluation system for research-oriented disciplines constructed in this study is relatively reasonable, scientific, reliable, and operable. The construction of the index system adapts to the characteristics of the development of research-oriented disciplines, with guiding significance for enhancing the development of research-oriented disciplines.

Construction of a risk prediction and evaluation system for postoperative incisional infection after spinal surgery / 中华创伤骨科杂志

Objective:To construct a risk prediction and assessment system for incisional infection after spinal surgery.Methods:Based on the failure mode and effect analysis (FMEA), risk factors and assessment indicators of postoperative incisional infection in spinal surgery were sorted out through literature search followed by expert consultation using the Delphi expert consultation method. After three-level assessment indicators were selected according to their importance and expert opinions and assigned by different scores, a risk prediction and evaluation system was constructed for postoperative incisional infection after spinal surgery.Results:The 2 rounds of expert consultation questionnaire resulted in an effective response rate of 100%. The degree of expert consultation authority was 0.85, showing high reliability; the Kendall coordination coefficients of expert consultation ranged from 0.525 to 0.686, showing good coordination ( P<0.05). The three-level assessment indicators consisted of 3 primary, 18 secondary and 54 tertiary ones. After statistical analyses of the important risk indicators selected which consisted of 6 preoperative evaluation ones and 18 postoperative evaluation ones, 6 preoperative and 12 postoperative predictive indicators were obtained. The values of risk priority number (RPN) were calculated for high, medium and low risks for postoperative incisional infection using a semi-quantitative method. Conclusion:A self-designed system has been constructed for risk prediction and assessment of incisional infection after spinal surgery based on expert consultation and FMEA method.

The construction of sports public service system for the elderly from the perspective of healthy aging / Estructura del sistema de servicios públicos para los deportes de edad en el contexto del envejecimiento saludable / Construção de um sistema de serviço público de desportos para idosos sob a perspectiva do envelhecimento saudável

ABSTRACT With the gradual improvement of people's quality of life, the average life expectancy of our country has been extended. It is estimated that the total number of the elderly population in China will exceed 250 million by the end of 2020. Therefore, promoting healthy aging is a necessary measure to cope with the coming aging society in China, and physical exercise is an important method to keep the physical and mental health of the elderly. In order to promote the development of healthy aging in China, this study focused on the current level of public sports services for the elderly. This study uses the expert consultation method to test the rationality of the evaluation index, and uses the method of questionnaire survey to score each evaluation index, and uses the analytic hierarchy process (AHP) to calculate the weight of the index. Finally, the paper takes the public sports service of the elderly in a city as an example to verify. The results show that the level of sports public service for the elderly in this city is only 77,928. Especially the two aspects of allocation of sports venues and the use of funds are the most unsatisfactory ones. It can be targeted to improve these two aspects, so as to improve the level of public sports services for the elderly. It is hoped that, through this study, we can provide some reference for improving the level of sports public service for the elderly from the perspective of healthy aging.

RESUMO Com a melhoria gradual da qualidade de vida das pessoas, a expectativa média de vida do nosso país foi ampliada. Estima-se que o número total de pessoas idosas na China excederá 250 milhões até o final de 2020. Por isso, promover um envelhecimento saudável é uma medida necessária para lidar com a futura população idosa na China, e o exercício físico é um método importante para manter a saúde física e mental dos idosos. A fim de promover o desenvolvimento de um envelhecimento saudável na China, este estudo centrou-se no nível atual de serviços desportivos públicos para os idosos. Este trabalho utiliza o método de consulta de especialistas para testar a racionalidade do índice de avaliação, e utiliza o método de levantamento por questionário para marcar cada índice de avaliação, e utiliza o processo hierárquico analítico (AHP) para calcular o peso do índice. Finalmente, a pesquisa toma como exemplo o serviço público de desportos dos idosos numa cidade. Os resultados mostram que o nível de serviço público desportivo para os idosos nesta cidade é apenas 77.928. Em especial, os aspectos da atribuição de espaços desportivos e a utilização de recursos financeiros são os mais insatisfatórios. Pode visar-se melhorar esses dois aspectos, de modo a melhorar o nível dos serviços desportivos públicos para os idosos. Espera-se que, através deste estudo, possamos oferecer uma referência para melhorar o nível de serviço público desportivo para os idosos sob a perspectiva do envelhecimento saudável.

RESUMEN Con la mejora paulatina de la calidad de vida de las personas se ha ampliado la esperanza de vida media de nuestro país. Se estima que el número total de personas añosas en China superará los 250 millones a finales de 2020. Por lo tanto, promover un envejecimiento saludable es una medida necesaria para hacer frente al aumento de la edad de la sociedad en China. El ejercicio físico es un método importante para mantener la salud física y mental de las personas mayores. Con el fin de promover el desarrollo del envejecimiento saludable en China, este estudio se centró en el nivel actual de los servicios deportivos públicos para las personas añosas. Este estudio utiliza la consulta de expertos para probar la racionalidad del índice de evaluación, la encuesta de cuestionario para calificar cada índice de evaluación, y el proceso de jerarquía analítica (PJA) para calcular el peso del índice. Finalmente, el trabajo toma como ejemplo a ser verificado, el servicio público deportivo de la tercera edad en una ciudad determinada. Los resultados muestran que el nivel de servicio público deportivo para personas añosas en esa ciudad es de solo 77.928. Especialmente los aspectos de la asignación de instalaciones deportivas y del uso de fondos son los más insatisfactorios. Se debe apuntar a mejorar estos dos aspectos, a fin de conseguir un mejor nivel de servicios deportivos públicos para las personas añosas. Esperamos que, a través de este estudio, podamos proporcionar una referencia para mejorar el nivel de servicio público deportivo para las personas añosas desde la perspectiva del envejecimiento saludable.

Injury prevention among young people in nursing homes: Recommendations following expert consultation forums.

BACKGROUND: Approximately 6,000 people under the age of 65 years reside in nursing homes each year in Australia. These young people in nursing homes are at risk of premature death and preventable morbidity from injuries. Choking and falls are the leading causes of premature deaths in this cohort with reported rates of 44% and 33%, respectively. OBJECTIVES: To develop injury prevention recommendations for young people in Australian nursing homes. METHODS: This mixed-methods study comprised two expert consultation panels and a follow-up survey. Two expert and stakeholder consultation panels used a modified nominal group technique to formulate recommendations. A short survey was subsequently given to participants to validate responses from the panels and to provide an opportunity to evaluate and rank recommendations. RESULTS: Ten recommendations were formulated for consideration that focused on system-wide reforms. Four were ranked as most important for implementation: education and training for nursing home staff; implementation of National Disability Insurance Scheme; support for coordinated care; and increasing residential housing stock that is appropriately designed. CONCLUSION: Extensive changes are needed to prevent injury for young people in nursing homes. Implementation should reduce the risk of injury and lead to an improved quality of life for this cohort. IMPLICATIONS FOR PRACTICE: This study provides an evidence base for aged care practitioners to improve practice within nursing homes to reduce fatal and non-fatal injuries for young people in nursing homes.

Construction of competency index of nurses in public health emergencies based on iceberg model / 中国实用护理杂志

Objective:To construct competency index of nurses in public health emergencies based on iceberg mode.Methods:Based on the analysis of the work of public emergencies in the past five years, the deficiencies were summarized, and the competence index of nursing staff in public health emergencies was preliminarily formulated with the Iceberg Model as the theoretical framework and the literature review. The Delphi expert consultation method was used to select 15 experts from 7 Class Ⅲ Grade A general hospitals and Class Ⅲ Grade A specialized hospitals in Jiangsu Province who met the standards of admission and discharge from January to June 2020 for two rounds of consultation, and the competency index was finally formed.Results:The competency index of nursing staff in public health emergencies included 5 first-level indicators and 27 second-level indicators. The authority coefficient of experts on the first-level index and second-level index were 0.84 and 0.81. The coordination coefficients were 0.68 and 0.72, respectively. The differences were statistically significant( χ2 values were 73.22, 95.30, P<0.01). Conclusions:The competency index of nurses in public health emergencies in this study is highly reliable and scientific, and can provide reference for the reserve, training and assessment of nurses in public health emergencies.

Methodological exploration of health Impact assessment of public policy / 公共卫生与预防医学

Objective This article takes a cosmetics factory in Yichang City as an example, uses a variety of methodologies to explore methods of health impact assessment and provides methodological references for future health evaluation of related public policies. Methods By analyzing the environmental assessment report of the cosmetic renovation project, an indicator system was established and expert consultation meetings were conducted to score the impact of the corresponding indicators on health. The impact of the renovation project of the factory on the factory workers, surrounding residents and the sustainable development of the environment was analyzed by means of the Kaiser model with the risk matrix and the Borda value. Results The risk values of the five influencing factors of industrial wastewater, domestic wastewater, industrial waste gas, industrial waste and noise were 5.11%, 5.43%, 10.6%, 6.71% and 7.02% respectively. All the influencing factors were in the green zone of the risk matrix. The Borda values of the five influencing factors of industrial waste water, domestic waste water, industrial waste gas, industrial waste residue and noise were 4, 5, 10, 7 and 5 respectively. Conclusion The multiple methodologies adopted in the factory renovation project are feasible, and can provide new ideas for the health impact assessment of public policies in the future.

Hot topic: Health and welfare challenges in the marketing of male dairy calves-Findings and consensus of an expert consultation.

A diverse group of Canadian experts was convened for a focused 2-d discussion on potential health and welfare problems associated with the marketing (i.e., transportation and sale) of male dairy calves. Written notes and audio recording were used to summarize the information provided on transport times and marketing practices. Content analysis was used to develop a consensus statement on concerns, possible solutions, and recommendations to improve male dairy calf marketing. The group noted that calves across all Canadian regions are commonly transported at 3 to 7 d of age and undergo transport for 12 to 24 h or longer depending on the location of their dairy farm of origin. Calves in some regions are marketed almost exclusively through auction markets, whereas others have more direct sales. A need was identified for better criteria for calf fitness for transport, maintaining farm biosecurity, reducing the use of antimicrobial therapy in calf production, and improving education for farmers and veterinarians on the importance of neonatal care for male dairy calves before transportation. Experts noted that major changes in male dairy calf marketing will be required to comply with amendments to the federal Health of Animals Regulations (Part XII) on animal transportation; collaborative effort will be needed to safeguard animal health and welfare as this transition is made.

Does external reference pricing deliver what it promises? Evidence on its impact at national level.

BACKGROUND: External reference pricing (ERP) is widely used to regulate pharmaceutical prices and help determine reimbursement. Its implementation varies substantially across countries, making it difficult to study and understand its impact on key policy objectives. OBJECTIVES: To assess the evidence on ERP in different settings and its impact on key health policy objectives, notably, cost-containment, pharmaceutical price levels, drug use, equity, efficiency, availability, affordability and industrial policy; and second, to critically assess the quality of evidence on ERP. METHODS: Primary and secondary data collection through a survey of leading experts and a systematic literature review, respectively, over the 2000-2017 period. RESULTS: Forty five studies were included in the systematic review (January 2000-December 2016). Primary evidence was gathered via survey distribution to experts in 21 countries (January-July 2017). ERP contributes to cost-containment, but this is a short-term effect highly dependent on the way ERP is designed and implemented. Low prices, as a result of ERP, can undermine the availability of medicines and lead to launch delays or product withdrawals. Downward price convergence can hamper investment in innovation. ERP does not seem to promote efficiency in achieving health system goals. As evidence is weak, results need to be interpreted with caution. CONCLUSIONS: ERP has not regulated prices efficiently and has unintended consequences that reduce the benefits arising from it. If ERP is carefully designed with minimal price revisions, prudent selection of basket size and countries, and consideration of transaction prices, it could be a more effective mechanism enhancing welfare, equitable access to medicines within countries and help promote industry innovation.

Study on Sustainable Development Ability Evaluation Index System for Ethnomedicine Enterprises in Guizhou Province / 中国药房

OBJECTIVE：To establish sustainable development ability evaluation index system for ethnomedicine enterprises in Guizhou province ，and to promote the sustainable development of the ethnomedicine industry. METHODS ：The draft of evaluation index system had been made by documents collection and a meeting of focus group discussion ，the final indexes and weight had been determined by Delphi method for conducting 2 rounds expert questionnaire survey ；the index system was used to measure and compare the results with the evaluation results of the drug regulatory department and the authoritative experts of the industry. RESULTS：The draft of evaluation index system included 6 indexes in the first level indicators and 49 indexes in the second. The expert’s positive coefficients was 100％ after 2 rounds of consultation ；the authoritative coefficients on the opinions of experts for the levels of indicators were 0.86，the coordination coefficient of experts was 0.22 in the first round and 0.48 in the second. After 2 rounds of expert consultation ，the final established evaluation index system contained 6 indexes in the first level indicators and 33 indexes in the second. Fifteen ethnomedicine enterprises in Guizhou province were selected for on-site testing. The evaluation results were not much different from those of the drug regulatory department and the authoritative experts of the industry. CONCLUSIONS：Established sustainable development ability evaluation index system for ethnomedicine enterprises is scientific ， reasonable and feasible ，and can provide standardized reference for regular monitoring and evaluation.

Variations in external reference pricing implementation: does it matter for public policy?

BACKGROUND: External reference pricing (ERP) seeks to rationalize prices and contain costs using foreign prices as a reference for the determination of domestic prices and is often used as the starting point for the facilitation of negotiations between health authorities and pharmaceutical manufacturers. METHODS: A systematic literature review was used to identify characteristics of ERP implementation across 29 countries. Primary data collection, in the form of surveys directed at key stakeholders, was also used to supplement data in instances where information received from the systematic literature review was outdated or minimal. Findings from the systematic literature review and primary evidence from key stakeholders were bench-marked against 14 best practice principles inherent to an optimal ERP system. RESULTS: Significant heterogeneity in ERP implementation across countries was identified. Country basket size, pricing calculation, and frequency of price revisions varied between countries. Belgium, France, and South Africa were more likely to adhere to the best practice principles, whilst Bulgaria, Hungary, and Romania had the most instances of non-adherence. CONCLUSION: The observed heterogeneity has policy implications for governments including globally declining pharmaceutical prices, launch delays in lower income countries, reduced incentive for continued R&D, and reduced access to medicines. Overcoming this issue to ensure that ERP is beneficial to all stakeholders will require a focus on developing sustainable, transparent, simple, and stable systems using a set of key guidelines that should maximize the benefits of the pricing policy.