Web-based decision aids for cancer clinical decisions: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types. METHODS: Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e.g., decision category, sample sizes, and outcome indicators) using a data-extracting form and performed risk of bias assessment of the included studies with Begg's test, Egger's test, and Cochrane Collaboration's tool. Meta-analysis of the pooled effects of WDAs on outcome indicators was performed via Review Manager 5.2. RESULTS: A total of 24 RCTs met the inclusion criteria, involving 9846 participants. Overall meta-analysis revealed statistically significant effects on cancer decisional conflict, knowledge, and making informed choice with the overall effect sizes being -0.29 (standardized mean difference, SMD), 0.47 (SMD), and 1.92 (risk ratio, RR) respectively. Subgroup analysis revealed significant effects in indicators including decisional conflict, knowledge, satisfaction, participation in decision-making, and screening behavior, though some extent of heterogeneity and quality flaws existed among the included studies. CONCLUSIONS: Although our research results showed evidence of WDA effects on certain outcome indicators of cancer decisions, these results should be interpreted with caution given the heterogeneity and quality flaws. It is still premature to conclude whether WDA was effective in optimizing cancer clinical decision-making, and more efforts are needed in this area. PROSPERO REGISTRATION NUMBER: CRD42020218991.

Personalized hypertension management based on serial assessment and telemedicine (PHMA): a cluster randomize controlled trial protocol in Anhui, China.

BACKGROUND: Despite tremendous investment worldwide, hypertension treatment and control rates remain low. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient's dynamic complications and contexts. METHODS/DESIGN: PHMA strives to reduce hypertension harms by eight "objective behaviors" (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors. DISCUSSION: PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making. Trial registration ISRCTN10999269. July 17, 2020; https://doi.org/10.1186/ISRCTN10999269 .

Smartphone and web-based independent consultation and feedback for joint replacement surgeries: a randomized control trial protocol.

BACKGROUND: Cost control and usage regulation of medical materials (MMs) are the practical issues that the government pays close attention to. Although it is well established that there is great potential to mobilize doctors and patients in participating MMs-related clinical decisions, few interventions adopt effective measures against specific behavioral deficiencies. This study aims at developing and validating an independent consultation and feedback system (ICFS) for optimizing clinical decisions on the use of MMs for inpatients needing joint replacement surgeries. METHODS: Development of the research protocol is based on a problem or deficiency list derived on a trans-theoretical framework which incorporates including mainly soft systems-thinking, information asymmetry, crisis-coping, dual delegation and planned behavior. The intervention consists of two main components targeting at patients and doctors respectively. Each of the intervention ingredients is designed to tackle the doctor and patient-side problems with MMs using in joint replacement surgeries. The intervention arm receives 18 months' ICFS intervention program on the basis of the routine medical services; while the control arm, only the routine medical services. Implementation of the intervention is supported by an online platform established and maintained by the Quality Assurance Center for Medical Care in Anhui Province, a smartphone-based application program (APP) and a web-based clinical support system. DISCUSSION: The implementation of this study is expected to significantly reduce the deficiencies and moral hazards in decision-making of MMs using through the output of economic, efficient, sustainable and easy-to-promote cooperative intervention programs, thus greatly reducing medical costs and standardizing medical behaviors. TRIAL REGISTRATION NUMBER: ISRCTN10152297.

[Research on the Construction of SPD Intelligent Logistics].

This paper introduced the workflow and use effect of SPD intelligent logistics supply chain management system in medical consumables management, analyzed the problems encountered in the process of hospital introduction of SPD management mode, and used PDCA principle to promote the hospital SPD before and after. using the PDCA principle to SPD before and after the introduction in such aspects as propaganda, information, system, safety management process continuously improve, in order to enhance the level of hospital consumables lean management and provide the reference for the introduction of the management system of hospital.

Application and Evaluation of SPD Based Logistics Management Model for Medical Consumables in Clinical Nursing Departments.

BACKGROUND: Supply, processing, and distribution (SPD) model is sparingly used in hospitals in China. We evaluated its effects on the management efficiency, quality control, and operating costs of medical consumables (MCs) in the clinical nursing surroundings in a single Chinese hospital-Anhui Provincial Hospital from 2014 to 2015. METHODS: Amount-based packages (ABP) and procedure-based packages (PBP) models were created. They were introduced the use of quick response (QR) code scanning for using in clinical nursing departments (CNDs). Questionnaires were prepared by referring to previous literature and using Delphi method repeatedly, further discussed and formalized. Partial results of the formal questionnaire were analyzed using SPSS. RESULTS: Frequency of MCs claims reduced without any requirements of MCs in 70% of CNDs. Average time spent on the inventory per week decreased and the time required to procure MCs reduced. Moreover, the average satisfaction score with MCs management increased, reaching 100%. Average space occupied by MCs decreased significantly, reducing by 1.2444m3. Overall, 100% of the respondents concluded that the management of MCs improved effectively and the inventory turnover rate had accelerated. The cost of MCs decreased by 15% with more than 10% increase in in-hospital amount, and the average daily cost of MCs also showed decrease. CONCLUSION: SPD can improve the efficiency of MCs management in CNDs, reducing medical risks and disputes, saving hospital operating costs, and decreasing capital occupation.

Synthetic Study toward Total Synthesis of (±)-Germine: Synthesis of (±)-4-Methylenegermine.

The total synthesis of 4-methylenegermine is described.

The Application of Collaborative Business Intelligence Technology in the Hospital SPD Logistics Management Model.

BACKGROUND: We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. METHODS: We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. RESULTS: For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. CONCLUSION: Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers.

SPD-based Logistics Management Model of Medical Consumables in Hospitals.

BACKGROUND: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. METHODS: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. RESULTS: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. CONCLUSION: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

Refining and validating a two-stage and web-based cancer risk assessment tool for village doctors in China.

The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and web- based cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..