Objective To explore the evaluation index and appointment mechanism of healthy professional titles. Methods We collected the data of people evaluated and appointed as advanced professional titles, and the evaluation and appointment documents in West China Hospital. We analyzed the evaluation index and appointment mechanism. Results A total of 400 people gained senior title promotion. The evaluation indexes focused on academic degrees, papers, research projects, patents, as well as awards and honors. The research achievements reduced of 80% people who had gained senior titles. Conclusion Current evaluation indexes prefer to inflexible index and ignore flexible index. The appointment mechanism lacks outcome evaluation, and the professional title will not be eliminated once appointed. In the future, we should improve the evaluation index and appointment mechanism focusing on the specific characteristics of healthy professional titles.
The background and status of the quality assessment instruments of clinical trials, and several frequently used instruments both domesticly and abroad were introduced, and the problems in this field were discussed.
ObjectiveTo systematically review the clinical applicability of the global guidelines evaluation index system, and to provide some foundation for the evidence-based establishment of the clinical applicability evaluation index system in China. MethodsThe PubMed, Embase, Cochrane Library, CNKI, WanFang and VIP databases were electronically searched to collect literature on the clinical applicability evaluation index system of guidelines from inception to November 2022. Two reviewers independently screened literature, extracted data and then organized the data to form the evaluation items pool through qualitative systematic review and thematic synthesis. ResultsA total of 82 articles were finally included, and 141 clinical applicability evaluation indicators were obtained, including 5 third-level topics, 14 analytical topics and 141 descriptive topics. The third-level topics were availability, readability, feasibility, acceptability and overall evaluation. Influencing factors in the feasibility field were summarized as medical staff factors, patient/patient family factors, environmental factors and guideline factors. ConclusionThis study systematically sort out the applicability evaluation items of the guidelines, which provide an evidence-based reference for the construction of relevant evaluation index systems in China.
Objective To evaluate the right usage of statistical methods in medical articles. Methods 544 theses from eight medical journalspublished during1998 and 2005 were analyzed. Results 136 theses had obvious statistical errors,accounting for 25.00%. The main types of the errors were: the wrong methods of data analyzing for 61.76%, diagram error for 14.71%, nonstatistical dealing for8.82%, the mixture of rate and ratio for 8.82%, and the other error for 5.88%. Conclusion The statistical methods should be highly valued. Despite handing themanuscript to the specialist in the same field, the statistician checking system should be built through the process of manuscript dealing.
ObjectivesThis study aimed to evaluate the validity and reliability of the clinical practice guidelines (CPGs) applicability evaluation tool, a preliminary revised tool, by using it to appraise specific clinical guidelines.MethodsMedical staffs were sampled from relevant departments in domestic medical institutions to use tool to evaluate the two guidelines. Spearman-Brown coefficient of odd-even split-half method and Cronbach's alpha coefficient were used to evaluate the split-half reliability and internal consistency reliability. The convergent and discriminant validity were evaluated by correlation analysis and correlation coefficient comparison hypothesis test, and the structural validity was investigated by confirmatory factor analysis based on structural equation.ResultsThe split-half reliability of the evaluation tool was 0.86, and the Cronbach's coefficient of the whole tool and each dimension were greater than 0.7 for two guidelines. The success rates of tool convergent and discriminant validity calibration were 100%. In the second-order confirmatory factor analysis model, the χ2 and df were 3.38 and 2.46, the comparative fit index (CFI) were 0.872 and 0.974, the goodness of fit index (GFI) were 0.954 and 0.983, and the adjusted goodness of fit index (AGFI) were 0.846 and 0.959 for two guidelines respectively. Both standard root mean square residual (SRMR) and root mean square error of approximation (RMSEA) were less than 0.09. Both P values of RMSEA hypothesis test were greater than 0.05.ConclusionsThe evaluation scale is a valid and reliable instrument for assessing the applicability of CPGs, which should be further evaluated in practical applications in the future.
Objective To evaluate the effect of triple arthrodesison treating complications of calcaneus fractures. Methods From 1990to 2001, 12 patients with the complications of calcaneus fractures underwent the triple arthrodesis(subtalar,talaronavicular and calcaneocuboid joints). Ollier incision was applied to all patients. Peroneal tenolysis was required in 2 patients and a decompression and transposition of tibialnerve in 1 patient.Of the 12 patients, 7 were males and 5 were females. Their ages ranged from 29 to 64 years. Complications, like pain and deformity, occurred 5 to 22 months after the operation(18 months on average).Preoperative score, fibulocalcaneal distance, Bohler angle, differenceof talardeclination angle and height of hind foot were 40.00±5.22, 0.41±0.03 cm, 12.00±3.40°, 17.00±3.32° and 4.12±0.35 cm respectively. Results All patients were followed up from 3 to 13 years with an average of 7 years. Postoperative score, tibulocalcaneal distance, B[AKo¨]hler angle, difference of talar declination angle and height of hind foot were 75.00±6.46，0.73±0.02 cm， 31.00±5.61°，9.00±3.15° and 6.75±0.62 cm respectively. There were significant differences in these indexes(P＜0.05). Conclusion To evaluate the complications of calcaneus fractures and to adopt proper operative procedures are necessary. To restore theheight of hind foot and the anatomical relationship between hind foot and calcaneus is the key factor to success.
The method of evaluating clinical efficacy of traditional Chinese medicine is one of the hotspots in the field of traditional Chinese medicine in recent years. How to dynamically evaluate individual efficacy is one of the key scientific problems to explain the clinical efficacy of traditional Chinese medicine. At present, there are no recognized methods of evaluating individual efficacy of traditional Chinese medicine. In this study, we provided a method of dynamically evaluating individual efficacy of traditional Chinese medicine based on Bayesian N-of-1 trials after analyzing the current status of researches on methods of evaluating individual efficacy of traditional Chinese medicine. This method has the advantages of both N-of-1 trials and Bayesian multilevel models. It is feasible to evaluate individual efficacy of traditional Chinese medicine from the perspective of the design and analysis method. This study can provide an important basis for enriching and improving the methodology of evaluating individual efficacy of traditional Chinese medicine.
ObjectiveTo systematically review the economic evaluation research of anti-novel coronavirus infection drugs at home and abroad, so as to promote clinical rational drug use. MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, INAHTA, SinoMed, WanFang Data, and CNKI databases were systematically searched from January 1, 2020 to March 25, 2023, to collect economic evaluation studies related to anti-novel coronavirus infection drugs. ResultsA total of 22 articles were included, among which 11 studies were conducted from the perspective of health system, and most of the studies performed cost estimation on direct medical costs. The overall compliance rate of the included studies ranged from 42% to 70%, with deficiencies in model setting, incomplete uncertainty analysis, and lack of stakeholder participation. The results showed that immunotherapy drugs (Dexamethasone, Tocilizumab), neutralizing antibody (REGEN-COV antibody), small molecule drugs (Baricitinib, Nirmatrelvir/Ritonavir, Molnupiravir, Favipiravir) and statin were cost-effective. There was some variation in the results of the economic evaluation of Remdesivir. ConclusionAt present, there are few studies on the economic evaluation of drug interventions in COVID-19. Existing studies have pointed out that most drug interventions are cost-effective. It is suggested that more standardized pharmacoeconomic evaluation studies based on the actual situation of China epidemic should be carried out in the future.
ObjectiveTo analyze the roles of three scoring systems, i.e. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ranson’s criteria, and Sequential Organ Failure Assessment (SOFA), in predicting mortality in patients with severe acute pancreatitis (SAP) admitted to intensive care unit (ICU), and explore the independent risk factors for mortality in SAP patients.MethodsThe electronic medical records of SAP patients who admitted to ICU of West China Hospital, Sichuan University between July 2014 and July 2019 were retrospectively analyzed. Data of the first APACHE Ⅱ, Ranson’s criteria, SOFA score, duration of mechanical ventilation, the use of vasoactive drugs and renal replacement therapy, and outcomes were obtained. The receiver operator characteristic (ROC) curve was used to evaluate the value of APACHE Ⅱ score, Ranson’s criteria, and SOFA score in predicting the prognosis of SAP. Logistic regression models were created to analyze the independent effects of factors on mortality.ResultsA total of 290 SAP patients hospitalized in ICU were screened retrospectively, from whom 60 patients were excluded, and 230 patients including 162 males and 68 females aged (51.1±13.7) years were finally included. The ICU mortality of the 230 patients with SAP was 27.8% (64/230), with 166 patients in the survival group and 64 patients in the death group. The areas under ROC curves of APACHE Ⅱ, Ranson’s criteria, APACHE Ⅱ combined with Ranson’s criteria, and SOFA score in predicting mortality in SAP patients admitted to ICU were 0.769, 0.741, 0.802, and 0.625, respectively. The result showed that APACHE Ⅱcombined with Ranson’s criteria was superior to any single scoring system in predicting ICU death of SAP patients. The result of logistic regression analysis showed that APACHE Ⅱ score [odds ratio (OR)=1.841, 95% confidence interval (CI) (1.022, 2.651), P=0.002], Ranson’s criteria [OR=1.542, 95%CI (1.152, 2.053), P=0.004], glycemic lability index [OR=1.321, 95%CI (1.021, 1.862), P=0.008], the use of vasoactive drugs [OR=15.572, 95%CI (6.073, 39.899), P<0.001], and renal replacement therapy [OR=4.463, 95%CI (1.901, 10.512), P=0.001] contributed independently to the risk of mortality.ConclusionsAPACHE Ⅱ combined with Ranson’s criteria is better than SOFA score in the prediction of mortality in SAP patients admitted to ICU. APACHE Ⅱ score, Ranson’s criteria, glycemic lability index, the use of vasoactive drugs and renal replacement therapy contribute independently to the risk of ICU mortality in patients with SAP.
Objective To evaluate quality and current status of traditional Chinese medicine (TCM) guidelines and consensus, and to promote the improvements in the quality of guidelines and consensus. Methods A systematic collection of TCM guidelines and consensus published in medical journals in 2022 was conducted. We used scientific, transparent, and applicable ranking tools (STAR) for evaluation, analyzed the scoring rates (%), and assessed the quality level and influencing factors of guidelines and consensus through methods such as comparison and stratification. Results A total of 130 TCM guidelines and consensus were included. Guideline areas with higher scores included recommendations (65.3%), evidence (55.9%), and guideline development groups (54.2%). In the case of consensus, higher scores were observed in recommendations (38.7%), guideline development groups (37.0%), and funding (30.0%). The total score rate of TCM guidelines exceeded that of national guidelines, while the consensus rate was lower. Stratified analysis revealed statistical differences in guideline score rates among journals and issuing institutions, as well as significant differences in consensus score rates among journals, formulation institutions, subjects, and funding categories. Conclusion The quantity and quality of TCM guidelines and consensus are on a positive trajectory, with higher quality levels in guidelines than in consensus. The overall quality of TCM guidelines surpasses that of national guidelines, particularly emphasizing the scientificity of guideline formulation. However, the overall quality of consensus remains lower than that of the national consensus. Factors such as journals, formulation institutions, subjects, and funding categories are identified as potential influences on the quality of TCM guidelines and consensus.