After the reform of drugs and medical consumables, the problem of unreasonable medical examination has gradually become prominent, which has become the potential threat of doctor-patient disputes and rising medical costs. At present, the reform of the medical and health system has entered the deep water zone. In the process of standardized management of medical examination, the difficulties in doctor-patient trust, medical examination supervision, medical examination resource allocation, the implementation of the mutual recognition system of medical results and the guarantee of information security have gradually emerged. In view of the dilemma of medical examination control, this paper proposes the following three breakthrough paths: based on the perspective of doctors and patients, improve doctor-patient trust; coordinating institutional supervision and administrative supervision to create transparent medical examinations; technical support to promote the standardized operation of medical examination, in order to provide a theoretical basis for the standardized operation of medical examination.
The purpose of this paper is to discuss the evaluation standard of rationality of medical examination from different perspectives, so as to provide theoretical evidence for medical department to establish the evaluation standard of the rationality of medical examination. By researching the relevant literature in the field of rational medical examination and combing the existing research results, this paper discusses the evaluation criteria of the rationality of medical examination from four dimensions: technology, ethics, law, and health economy. The following four suggestions are proposed for the current status of medical examination: construct clinical pathway management to avoid excessive medical examination; establish the internal supervision and evaluation mechanism to improve the professional quality of medical staff; improve medical examination-related policies, laws, and regulations, carry out specialized legislation; apply diagnosis-related group payment method, control the cost of medical examination.
Objective To investigate drug usage and costs of angina inpatients in Karamay Central Hospital in 2014 and to provide evidence and reference for evidence-based pharmacy study of single disease in circulation system. Methods The information of drug use and expenditure of angina inpatients were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results We included 351 angina inpatients in Karamay Central Hospital in 2014 whose average age was 69.44±10.65 years old. Fifty-one kinds of drugs were used for angina therapy. The expenditure of drugs was 122.46 yuan per person. The symptomatic treatment drugs included 11 kinds of drugs. The top 3 usage drugs were isosorbide denigrates, aspirin, nitroglycerin. The secondary prevention medicines included 35 kinds of drugs, and were prescribed for 1 953 times; the anti-hypertensive drugs were most prescribed. The Chinese patent medicine were prescribed for 69 times. The compound Danshen dripping pill was the most prescribed drug. In total expenditure, the cost of clopidogrel, atorvastatin, irofiban ranked top three. Rivaroxaban, tirofiban, low molecular weight heparin were the top 3 drugs for per-time expenditure. Conclusion The top 3 used drugs are isosorbide denigrates, aspirin, nitroglycerin for angina inpatients in Karamay Central Hospital in 2014, while the top 3 total expenditure drugs are clopidogrel, atorvastatin and irofiban.
The current quantitative methods of bilirubin have disadvantages such as high cost and low sensitivity. Due to the negative correlation between the level of serum bilirubin and the risk of cardiovascular diseases, a fluorescent ratiometric film sensor was developed aiming at bilirubin detection at low level concentration. Blue-emitting and red-emitting gold nanoclusters were assembled into the same film using layer-by-layer self-assembly technology. Detection of bilirubin was achieved based on the intensity ratio of the two nanoclusters. Bilirubin exposure causes fluorescent quenching of the film. The fluorescence intensity ratio of the two cluster probes had quantitative relationship versus bilirubin concentration. Based on this film sensor, a portable fluorescence detection system was designed for the ratiometric sensing of bilirubin. The hardware of the system was mainly composed of main control chip STM32F407, TSL237 and TSL238T optical frequency sensor. A light-avoiding dark room and detection light path were designed through three-dimensional printing to reduce the interference from ambient light and improve detection accuracy. Experimental results showed that the proposed detection system had strong anti-interference, good stability and accuracy. The linear coefficient of bilirubin detected by this system was 0.987. The system presented good results in reproducible experiments and possessed a good linear relationship with the data obtained by standard spectrofluorometer. The portable system is expected to detect serum bilirubin at low levels.
Objective To investigate drug usage and costs of ischemic stroke inpatients in Karamay Central Hospital in 2014 and to provide evidence and reference for evidence-based pharmacy study of single disease in circulation system. Methods The information of drug use and expenditure of ischemic stroke inpatients were collected from the hspital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results We included 522 ischemic stroke inpatients in Karamay Central Hospital in 2014, the average age was 67.58±13.27 years old. Forty three kinds of drugs were used for ischemic stroke therapy. The total expenditure of drugs was 10.94 million and 1 807.99 yuan per person. The most used drugs were for symptomatic treatment which included 18 kinds of drugs. The using frequency of aspirin, edaravone, oxircetan were the highest. The secondary prevention medicines included 23 kinds of drugs. The anti-hypertensive, lipid-lowering and hypoglycemic agents were prescribed mostly. Traditional Chinese medicines were prescribed 234 times, and the injection Ligustrazine with glucose was the most used drug. Conclusion The mainly drugs for treatment of ischemia stroke inpatients in Karamay Central Hospital in 2014 are aspirin, edaravone and oxircetan; while the expenditure of clopidogrel and oxiracetam were the highest.
ObjectiveTo analyze the clinical distribution and changes of antimicrobial resistance profiles of Staphylococcus aureus (SA), as well as to provide the basis for the prevention and treatment of infection. MethodsThe clinical data and the antimicrobial resistance profiles of SA were collected from Jan, 2008 to Dec, 2014 in West China Hospital of Sichuan University. The WHONET 5.5 software was used to analyze the resistance data. ResultsA total of 5 698 SA isolates were included within 7 years. Of all strains, 2 721 (47.8%) were isolated from secretion, 1 638 (28.75%) were from respiratory tract specimens, 451 (7.9%) were from pus, and 362 (6.4%) were from blood. 811 (49.5%) SA isolates from respiratory tract specimens were Methicillin-resistant Staphylococcus aureus (MRSA), which was higher than those from secretion, pus and blood. 1052 (18.5%) SA strains were isolated from the dermatological department, 604 (10.6%) were from the orthopedics department, 472 (8.3%) were from the intensive care unit (ICU), 471 (8.3%) were from the department of burn, and the detection rate of MRSA from ICU (341, 72.2%) was the highest. During last 7 years, the total separation rate of SA was 8.2%, among them 1 858 (32.6%) MRSA were isolated, and the detection rate was 32.6%. The resistant rate of SA to erythromycin, clindamycin, tetracycline, gentamicin, rifampin, ciprofloxacin, levofloxacin and moxifloxacin had a statistically significant decrease from 2008 to 2014, while the resistant rate of SA to trimethoprim/sulfamethoxazole had increased. No vancomycin, linezolid, teicoplanin or tigecycline resistant strain was detected. The resistance rates of MRSA to common antibiotics such as penicillin G, erythromycin, clindamycin, tetracycline, gentamicin, rifampin and fluoroquinolones were higher than those of MSSA, while the resistance rate of MRSA to trimethoprim/sulfamethoxazole was lower than MSSA. ConclusionCompared with the monitoring data in China, the drug resistance of SA in West China Hospital is well controlled. However, experience-directed antibiotic treatment of MRSA infection is still limited. MRSA infection remains a serious problem in critically ill patients. The rational use of antibiotics and application of effective infection control measures are important to decrease the MRSA infection.
ObjectiveTo evaluate the rationality of antibiotics use by analyzing the prescription reviewing results.MethodsThe review data of antibiotic prescriptions in Beijing Hospital was randomly selected from 2016 to 2019, from which unreasonable prescriptions and the antimicrobial agents were analyzed, and the use of antibiotics and unreasonable prescriptions annually were compared.ResultsThe evaluation of rational use of antibiotics involved 79 701 outpatient prescriptions from 2016 to 2019. There were 10 drugs in the top five irrational rates of outpatient antibiotics, primarily cephalosporin and quinolones, accounting for 50% and 30%, respectively. The primarily unreasonable problems were over prescription (common in gastroenterology and dermatology), unsuitable indications (common in otolaryngology), inappropriate usage and dosage (common in urology, dermatology and gastroenterology), and failure to write clinical diagnosis or incomplete clinical diagnosis (common in obstetrics and gynecology and general surgery). During the four years, the proportion of antibiotics prescriptions and the irrational rate decreased annually.ConclusionsThe use of antibiotics in outpatient department of Beijing Hospital has achieved initial results, however, there are still some problems. We should further strengthen the management of antibiotics usage, strengthen training and learning, and increase medical cooperation to promote rational drug use in clinic.
Objective To investigate drug usage and costs of children inpatients with bronchopneumonia in Karamay Central Hospital in 2014 and to provide baseline for evidence-based pharmacy study of single disease in respiratory system. Methods The information of drug use and expenditure of children inpatients with bronchopneumonia were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results A total of 890 children inpatients were included, the average age was 1.00±2.17 years old. Among the antibiotics of single therapy, the frequency of amoxicillin and clavulanate potassium for injection was highest. Among the antibiotics of combination therapy, the frequency of macrolides was highest. Conclusion The mainly drugs for treatment of children inpatients with bronchopneumonia in Karamay Central Hospital in 2014 is amoxicillin and clavulanate potassium for injection.
Rational drug use is a global concern. As one of the highest risk groups for drug use, children's rational drug use has always been concerned. Based on the previous research results of the research group, we developed evaluation indicator systems for assessing rational drug use to treat community-acquired pneumonia and primary nephrotic syndrome in children and proton pump inhibitors in pediatric intensive care units and finished empirical research. This study further summarizes and expounds the construction ideas of rational drug use evaluation indicators for children based on diseases or drugs, and provides a reference for constructing children's rational drug use evaluation indicators.
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.