As one of the most sophisticated research methods of evidence-based medicine, systematic review is an activity of collecting, arranging and analyzing medical information. The methodological characteristics of systematic review reflect the value orientation of this activity. By analyzing and summarizing these characteristics, this paper points that the process of systematic review reflects the value orientation of attaching importance to obtaining universal information sources, treating individual information in an add-weight way, discretion in interpreting results and updating of time-limited information in medical information activities.
As the medical industry continuously raises its demands for efficiency and quality, hospital performance management has gradually become the focus of reform. The Resource-based Relative Value Scale (RBRVS) evaluation system, as an effective performance evaluation tool, has been adopted and implemented by numerous hospitals both domestically and internationally. Based on the analysis of the current status of performance reform using RBRVS in hospitals at home and abroad, this article comprehensively introduces the origin, development, and basic principles of RBRVS. Furthermore, it provides an evaluation of the difficulties encountered in the practical application of this system and suggests optimization measures.
ObjectiveTo explore the value of ultrasonography in the diagnosis of gastrointestinal stromal tumors (GISTs). MethodWe retrospectively analyzed the clinical data of 110 patients with surgical pathology confirmed GISTs between January 2008 and December 2013. All the patients underwent routine ultrasound examination. Thirty-two patients accepted oral contrast enhanced bowel ultrasonography, and 5 patients underwent trans-rectal ultrasound (TRUS). ResultsA total of 107 cases were detected out of the 110 cases of GISTs by ultrasonography, and the other three cases were missed. Among the 107 cases, 104 were shown to be masses, and 3 had thick gastric or intestinal walls. Among the 104 masses, hypo-echoic lesions were found in 73, heterogeneous lesions were found in 25, and hyper-echoic lesions were found in 6; 30 cases of tumor were less than 5 cm in diameter, 54 were between 5 cm to 10 cm in diameter, and 20 were longer than 10 cm in diameter (including 5 were longer than 20 cm in diameter). In the 107 cases, 12 were found to have liver metastasis, 4 were detected to have abdominal lymph node enlargement, and 3 had ascites. Surgery and pathological results showed that among the 110 cases of gastrointestinal stromal tumors, 91 developed from the stomach and intestine and the other 19 were extra-gastrointestinal stromal tumors; 72 were at high risk, 21medium risk, and 17 low risk. ConclusionsThe detection rate of GISTs by ultrasonography is high, but the quantitative and qualitative diagnosis ability should be raised.
Comprehensive evaluation research of Chinese patent medicine (CPM) is performed to demonstrate the comprehensive value of CPM from multiple dimensions and to clarify the clinical value and positioning, so as to provide references for decision-making in health or drug policies. Therefore, to standardize and promote comprehensive evaluation studies on CPM, the current guideline introduced the specific requirements on the applicable subject, basic principles, and major evaluation content, thereby providing guidance for researchers in the future.
It's common that general rules exist in a certain classification. The general rules of expense classification enable us to judge the category of a patient as soon as possible and to curb the expense. Theory of rough set helps us reach the best reduction of attributes. Based on the core attributes, classification rules are put forward by value reduction. The results show that 10 core attributes remain in 21 attributes of 1527 inpatients' information and 76 classification rules are founded. All of 76 rules guide classification of the patients. 44 of the 76 rules define the only category of a patient, the other 32 rules defines the potential catagories of a patient. Meanwhile, equal attributes of the same category are summerized to guide the cost control of patients. The results indicate that the theory of rough set is effective in attributes reduction and rule generalization of patient expense classification, and it has important significance on medical practice.
ObjectiveTo analyze the multidetector computed tomography (MDCT) findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. MethodsSixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from Jun. to Oct. 2016 (acute appendicitis group), and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 (normal appendices group), were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included:location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results① Rate of appendices visualization. In total of 95.5% (63/66) appendices were visualized on MDCT in acute appendicitis group, while 95.0% (38/40) appendices were visualized on MDCT in normal appendices group (P > 0.05). ② Locations of appendices. Acute appendicitis group:appendices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group:appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices (P < 0.05). The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. ③ The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were (11.4±4.2) mm (6.2-21.9) mm and (4.3±2.2) mm (1.1-8.6) mm, respectively, while those in normal appendices group were (6.1±1.4) mm (3.7-8.6) mm and (1.7±0.8) mm (0.5-3.2) mm, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively (P < 0.05). ④ Contents of appendices. Acute appendices group:there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group:there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. ⑤ Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. ConclusionsMDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.
ObjectivesTo evaluate the characteristics, main contents, key elements and techniques of global drug value assessment tools, especially for those developed for antineoplastic agents, and to provide reference for the establishment of the first value assessment tool for antineoplastic agents in China.MethodsDatabases including MEDLINE, EMbase, CBM, CNKI, VIP, WanFang Data and 19 relevant websites of institutions and societies were searched from inception to October 31st, 2018 to identify all the drug value assessment tools worldwide. Two independent reviewers screened the literatures, extracted the data and cross-checked them according to the inclusion and exclusion criteria. A qualitative analysis was conducted to describe the characteristics of these drug value assessment tools, including the publishing organization, year of publication, country, applicable type of disease and drug category, result display, and etc. Key elements and techniques in terms of evaluation dimensions, sources and levels of evidence, methods and procedures to form the tool were compared.ResultsA total of 12 English drug value assessment tools were included, which were published in 2010 to 2018 exclusively from Europe and North America. The applicable types of diseases and drug categories are not identical. The target users and stakeholders of each tool were slightly different. Evaluation dimensions, sources and levels of evidence, methods and procedures to form the tool were vital issues in value evaluation for drugs.ConclusionsThe structures of existing drug value assessment tools were almost the identical. However, there is no consensus on value definitions, evaluation dimensions, sources of evidence and result display. Methods and procedures to form the tool are not well described. It is urgent to explore and develop a value-oriented, focused and feasible drug assessment tool for antineoplastic agents in order to satisfy the strategic requirements of value-based post-marketing drug reevaluation.
Objective To systematically review the requirements of patient participation in clinical practice guidelines (CPGs) in Chinese and foreign guideline development manuals. Methods Thirty-six authoritative society websites and guideline databases and 5 commonly used databases were searched online. Relevant information on patients’ participation in the guideline manuals was collected, summarized, and analyzed. Results A total of 37 manuals (33 foreign and 4 Chinese) were included. The requirements for the number of patients, the right to speak, status equality, and the right to vote in the guideline development manual accounted for 35.1%, 13.5%, 8.1%, and 5.4%, respectively. The requirements for participants’ mode of participation were not mentioned in the guideline development manuals from 2000 to 2010. There were 6 (16.2%) in 2011–2015 and 12 (32.4%) in 2016–2022. The comprehensive guidelines for multiple disease types accounted for 35.7%, 28.6%, and 57.1%, respectively, in terms of requirements for participants’ knowledge or experience, management of specialized personnel, and training support. The specific guidelines for a certain type of disease or drug accounted for 21.7%, 4.3%, and 17.4%, respectively; fifteen (40.5%) guideline development manuals mentioned the specific collection forms of patients’ values and preferences in guideline development. Conclusion Given changes to medical models and the emphasis on patients’ rights and interests, an increasing number of manuals have proposed requirements that consider the expression of patients’ values and preferences in manual development, and the dimensions of manual development are constantly enriched. However, manuals outlining the requirements of patient participation are still not comprehensive and can continue to improve.
Value-based healthcare (VBHC) is an important guideline for current and future healthcare services. In practice, VBHC should be the best goal of public welfare of healthcare service. Meanwhile, VBHC and cost-effectiveness analysis together provide scientific evidence for healthcare decision-making. Pay by value is inevitable in the next stage of the reform of the payment system of medical insurance, and the health service system should be reconstructed based on VBHC. Finally, the challenges of VBHC implementation are discussed.
ObjectivesTo initially construct a scientific, reasonable and precision medicine technology value judgment framework suitable for China’s national conditions based on expert consultation method, so as to provide scientific value judgment system support for China's medical insurance decision-making.MethodsThe preliminary evaluation indicator system for precision medicine technology value was established by using literature analysis and expert consultation method, and the direct weighting method was used to determine the indicators weight.ResultsAfter two rounds of expert consultation, an indicator system suitable for the value judgment of precision medicine technology in China was constructed, including 5 primary indicators (health needs, health effects, economics, innovation and suitability) and 14 secondary indicators. Each indicator was weighted according to importance.ConclusionsA set of precision medicine value judgment indicator system suitable for China has been initially established, which lays a certain foundation for further measurement research of the indicator system and provides a scientific basis for medical insurance decision-making.