ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To systematically review the willingness to use pre-exposure prophylaxis (PrEP) and its influencing factors among men who have sex with men (MSM) in China. Methods We conducted a comprehensive search on various databases, including China National Knowledge Infrastructure, VIP database, Wanfang data, China Biomedical Literature Service System, PubMed, Web of Science, Cochrane Library, and Embase, covering the period from database inception to September 6th, 2023. We focused on studies that publicly reported data on the willingness to use PrEP and its influencing factors among MSM in China. The quality of included studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. RevMan 5.3 software and Stata 13.1 software were used to perform meta-analysis for the willingness to use PrEP and its influencing factors among MSM in China. Results A total of 24 cross-sectional studies with 19 influencing factors and a sample size of 16499 participants were included in the review. The results revealed a PrEP usage intention rate of 60.4% [95% confidence interval (CI) (51.8%, 68.9%)] among the MSM population in China. Factors such as awareness of PrEP [odds ratio (OR)=5.26, 95%CI (1.33, 20.82)], having heard of PrEP [OR=1.84, 95%CI (1.28, 2.64)], age<25 years [OR=1.92, 95%CI (1.34, 2.77)], being a student [OR=1.92, 95%CI (1.17, 3.16)], monthly income of 1000-3000 yuan [OR=1.36, 95%CI (1.12, 1.65)], history of human immunodeficiency virus (HIV) testing [OR=2.05, 95%CI (1.53, 2.74)], history of sexually transmitted infections [OR=1.75, 95%CI (1.27, 2.40)], seeking sexual partners online [OR=1.38, 95%CI (1.19, 1.59)], openness about sexual orientation [OR=1.90, 95%CI (1.27, 2.84)], having a non-local household registration [OR=1.66, 95%CI (1.37, 2.02)], and recommending PrEP to friends [OR=20.14, 95%CI (2.59, 156.91)] were identified as promoting factors for the willingness to use PrEP. Conversely, a homosexual orientation [OR=0.67, 95%CI (0.52, 0.85)] was identified as a barrier to the willingness to use PrEP. Conclusions Chinese MSM have a low intention to use PrEP, and there are many factors affecting the intention to use PrEP in MSM. In the future HIV prevention and control work, measures such as strengthening education and publicity of PrEP, providing a certain degree of support for PrEP costs, strengthening health education on campus, strengthening community organizations and support networks should be taken to promote the willingness of MSM to use PrEP.
Objective To investigate the utilization of platinum drugs in 21 hospitals of Chengdu from 2011 to 2014. Methods The utilization information of platinum drugs in 21 hospitals of Chengdu from 2011 to 2014 was extracted, and the dosage form of drugs, consumption sum, frequency of drug use (DDDs), defined daily cost (DDC), and drug sequence ratio (B/A) were analyzed statistically. Results From 2011 to 2014, the total consumption sums and DDDs of platinum drugs were increased year by year. The consumption sums of oxaliplatin were the highest, and the consumption sums of carboplatin were increased year by year. Oxaliplatin, nedaplatin, and lobaplatin were ranked first, second and fifth respectively in all the four consecutive years; the total DDDs of patinum drugs from 2011 to 2014 showed a trend of increase, DDDs of cisplatin were always ranked first, followed by oxaliplatin; DDC and sorting of platinum drugs were relatively stable, and B/A values of carboplatin and cisplatin were close to 1.00. Conclusion The utilization of platinum drugs in 21 hospitals of Chengdu is in accordance with the principle of safety, effectiveness, economy and convenience.
The quality of disinfectant, disinfection devices and disposable medical devices is closely related to the patients' safety. Hospital infection management department must carry out the audit responsibilities for qualification documents of disinfectant, disinfection devices and disposable medical devices, to guarantee legality, safety and effectiveness of products used in hospital. This paper mainly introduces the implementation of qualification documents audit in West China Hospital, Sichuan University, including system construction, process reengineering, documents audit scope and key points, and document management.
Objective To broaden the current understanding of the usage willingness about artificial intelligence (AI) robots and relevant influence factors for elderly patients. Methods The elderly patients in the inpatient ward, outpatient department and physical examination of the Department of Geriatrics, West China Hospital of Sichuan University were selected by convenient sampling for investigation between February and April 2020, to explore the willingness of elderly patients to use AI robots and related influencing factors. Results A total of 446 elderly patients were included. There were 244 males and 202 females. The willingness to use AI robots was (14.40±3.62) points. There were statistically significant differences among the elderly patients with different ages, marital status, living conditions, educational level, current health status, current vision status, current hearing status, self-care ability and family support in their willingness to use AI robots (P<0.05). Multiple linear regression analysis showed that age, education level and family support were the influencing factors of use intention (P<0.05). Among the elderly patients, 60.76% had heard of AI robots, but only 28.03% knew the medical application of AI robots, and only 13.90% had used AI robot services. Most elderly patients (>60%) thought that some adverse factors may reduce their usage willingness, like “the price is too expensive” and “the use is complex, or I don’t know how to use”. Conclusions Elderly patients’ cognition of AI robots is still at a low level, and their willingness to use AI robots is mainly affected by age, education level and family support. It is suggested to consider the personalized needs of the elderly in terms of different ages, education levels and family support, and promote the cheap and user-friendly AI robots, so as to improve the use of AI robots by elderly patients.
It has been 36 years since the first version of essential medicine list (EML) was released by WHO in 1977,when 18 versions of WHO-EML and four versions of children essential medicine list have been released. In 1982, the first version of national essential medicine list (NEML) was released in China. Till 2012, there were eight versions of NEML in total. This paper introduces WHO-EML in aspects of origin, idea, definition, design, and innovation of selection methodology,principle, and workflow; compares the evolution, design, selection methodology between WHO-EML and Chinese NEML; and points out the challenges of evaluation and decision making of Chinese NEML.
ObjectiveTo explore the risk factors for surgical patients associated with postoperative nosocomial infection through monitoring the infection conditions of the patients, in order to provide a scientific basis for the development of hospital infection control measures in a second-grade class-A hospital in Chengdu City. MethodsWe conducted the survey with cluster sampling as the sampling method and the uniform questionnaire in the departments of orthopedic, neural and thoracic surgery from July 2011 to June 2012. The main parameters we observed were the patients'general and surgical conditions, antibiotics usage and hospital infection situation. Data were analyzed using the National Nosocomial Infection Surveillance Network software and chi-square test of single factors. ResultsIn this survey, we monitored 50 cases of postoperative hospital infection. The infection rate was 7.73% and the highest infection rate was in the Neurosurgery Department. The main site of infection was lower respiratory tract, followed by surgical site. The different usage time of antimicrobial drug in perioperative period resulted in different infection rates, and the difference was statistically significant (χ2=601.50, P<0.005). The rate of adjusted postoperative hospital infection was higher than pre-adjusted rate except that of the neurosurgery doctor 4. The risk factors associated with hospital postoperative infection in our hospital were:patients'conditions including underlying disease, emergency surgery, type of anesthesia, operative duration, hospital stay and postoperative drainage. Most of the hospital infection cases were caused by bacteria of the gram-negative bacilli, and the major pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in our hospital. ConclusionThe hospital should particularly strengthen the prevention and control of hospital infection in patients after neurosurgical operations. For patients with basic diseases, we should actively improve the patients'physical conditions before operation and control the primary lesion. Targeted control measures should be taken for different factors related to surgery. Reasonable selection of antimicrobial agents should be based on the epidemic strains in our hospital.
ObjectiveTo investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
With the real-world study (RWS) becoming a hotspot for clinical research, health data collected from routine clinical practice have gained increasing attention worldwide, particularly the data related to the off-label use of drugs, which have been at the forefront of clinical research in recent years. The guidance from the National Medical Products Administration has proposed that real-world evidence (RWE) can be an important consideration in supporting label expansions where randomized controlled trials are unfeasible. Nevertheless, how to use the RWE to support the approval of new or expanded indications remains unclear. This study aims to explore the structured process for the use of RWE in supporting label expansions of approved drugs, and to discuss the key considerations in such process by reviewing the documents from relevant regulatory agencies and publications from public databases, which can inform future directions for studies in this area.