Perioperative management of a patient with unexpectedly detected early-stage ovarian mucinous carcinoma combined with progressive bulbar paralysis: a case report and literature review.

BACKGROUND: Giant ovarian cysts (GOCs)complicated with progressive bulbar paralysis (PBP) are very rare, and no such literature about these cases have been reported. Through the diagnosis and treatment of this case, the perioperative related treatment of such patients was analyzed in detail, and early-stage ovarian mucinous carcinoma was unexpectedly found during the treatment, which provided reference for clinical diagnosis and treatment of this kind of diseases. CASE PRESENTATION: In this article, we reported a 38-year-old female patient. The patient was diagnosed with PBP 2 years ago. Examination revealed a large fluid-dominated cystic solid mass in the pelvis measuring approximately 28.6×14.2×8.0 cm. Carbohydrate antigen19-9(CA19-9) 29.20 IU/mL and no other significant abnormalities were observed. The patient eventually underwent transabdominal right adnexal resection under regional anesthesia, epidural block. Postoperative pathology showed mucinous carcinoma in some areas of the right ovary. The patient was staged as stage IA, and surveillance was chosen. With postoperative follow-up 1 month later, her CA19-9 decreased to 14.50 IU/ml. CONCLUSIONS: GOCs combined with PBP patients require a multi-disciplinary treatment. Preoperative evaluation of the patient's PBP progression, selection of the surgical approach in relation to the patient's fertility requirements, the nature of the ovarian cyst and systemic condition are required. Early mucinous ovarian cancer accidentally discovered after operation and needs individualized treatment according to the guidelines and the patient's situation. The patient's dysphagia and respiratory function should be closely monitored during the perioperative period. In addition, moral support from the family is also very important.

Medium-term clinical efficacy of endoscopic antireflux mucosectomy on laryngopharyngeal reflux: a retrospective multicenter cohort study.

BACKGROUND AND AIMS: Studies on the effect of antireflux mucosectomy (ARMS) on laryngopharyngeal reflux disease (LPRD) are lacking. We conducted a multicenter retrospective study to explore the clinical efficacy of ARMS on LPRD. METHODS: We retrospectively analyzed the data of patients diagnosed with LPRD by oropharyngeal 24-hour Dx-pH monitoring who underwent ARMS. The effects of ARMS on LPRD were evaluated by comparing the 36-Item Short-Form Survey (SF-36), reflux symptom index (RSI), and 24-hour Dx-pH monitoring scores before and 1 year after surgery. Patients were divided into groups according to gastroesophageal flap valve (GEFV) grade to explore the effect of GEFV on prognosis. RESULTS: One hundred eighty-three patients were included in the study. The oropharyngeal pH monitoring results showed that the effective rate of ARMS was 72.1% (132/183). After surgery, the SF-36 score was higher (P = .000), RSI score was lower (P = .000), and the symptoms of constant throat clearing; difficulty swallowing food, liquids, and pills; coughing after eating or after lying down; troublesome or annoying cough; and breathing difficulties or choking episodes were significantly improved (P < .05). Upright reflux was dominant in GEFV grade I to III patients, and the SF-36, RSI, and upright Ryan index scores were significantly improved after surgery (P < .05). In GEFV grade IV patients, regurgitation was dominant in the supine position, and the above evaluation indexes were worse after surgery (P < .05). CONCLUSIONS: ARMS is effective for LPRD. The GEFV grade can predict the prognosis of surgery. ARMS is effective in GEFV grade I to III patients, but the effect is not exact in GEFV grade IV patients and may even be aggravated.

Psychometric Comparison of EQ-5D-Y, CHU-9D, and PedsQL 4.0 in Chinese Children and Adolescents With Functional Dyspepsia: A Multicenter Study.

OBJECTIVES: This study aimed to assess and compare psychometric properties of the 3 health-related quality of life (HRQOL) instruments EQ-5D Youth version (EQ-5D-Y), Child Health Utility 9D (CHU-9D), and Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) in children and adolescents with functional dyspepsia (FD) in China. METHODS: A consecutive sample of FD outpatients were recruited from 6 tertiary medical centers in Hangzhou. The patients self-completed the 3 instruments in random order. Their feasibility, acceptability, construct validity (convergent, divergent, and known-group validity), and sensitivity were assessed. Multiple linear regression was used for identifying HRQOL-associated factors. RESULTS: A total of 1100 patients (mean age, 9.2 years; girl, 56.8%) completed the survey with no missing responses. Ceiling effect was quite higher in EQ-5D-Y (60.9%) than CHU-9D (33.8%) and PedsQL 4.0 (1.0%). The EQ-5D-Y and CHU-9D utility scores and PedsQL 4.0 total score were highly correlated (|r| = 0.593-0.661), except for the EuroQol visual analog scale score (EQ-VAS). The intraclass correlation coefficient between the 2 utility scores was fair (0.542). Most conceptually similar dimensions among the 3 instruments showed moderate to high correlations (|r| > 0.3) as hypothesized. The difference was statistically significant for the 2 utility scores and PedsQL 4.0 total score in varied severity groups (P < .001), and PedsQL 4.0 total score had higher relative efficiency and effect size values. The child's age, severity of FD symptoms, and their guardian's education had significant impact on HRQOL (P < .001). CONCLUSIONS: EQ-5D-Y, CHU-9D, and PedsQL 4.0 demonstrated acceptable psychometric properties in Chinese children with FD. PedsQL 4.0 showed superior sensitivity and is recommended. EQ-5D-Y and CHU-9D utility scores were not interchangeable. The measurement properties of EQ-VAS need to be further explored.

Using Time Trade-Off Values to Estimate EQ-5D-Y Value Sets: An Exploratory Study.

OBJECTIVES: The published international EQ-5D-Y-3L valuation protocol does not recommend the composite time trade-off (cTTO) method as the primary valuation method because of 2 major concerns. First, the cTTO method was shown to generate high values. Second, the cTTO method is not as feasible for valuing children's health as other established methods. This study aimed to explore the feasibility of using cTTO values alone to estimate EQ-5D-Y-3L value sets. METHODS: We analyzed the cTTO data derived from the recently completed Chinese EQ-5D-Y-3L valuation study in which a total of 28 health states were valued. We assessed the feasibility of the cTTO tasks in terms of survey completion time and participant-reported difficulty of understanding the task, differentiating the health states, and deciding the answer. We also examined the data distribution characteristics and modeled the data using different models. RESULTS: In total, 418 participants completed the cTTO interview. On average, participants took approximately 35.70 minutes (SD 12.42) to complete the interview and made 13.21 moves (SD 9.00) in the cTTO tasks. There were 74.16%, 59.33%, and 11.48% of participants indicated that it was easy to understand the cTTO tasks, easy to differentiate between the health states, and difficult to decide on an indifference point, respectively. The data distribution was smooth, and a random-effects model performed the best in terms of coefficient significance, monotonicity, and predictive accuracy. CONCLUSION: Our finding suggests that estimating EQ-5D-Y-3L value sets using cTTO data alone is feasible and therefore could be considered as an option in future valuation studies for EQ-5D-Y-3L.

Comparison of Evolocumab and Ezetimibe, Both Combined with Statin Therapy, for Patients with Recent Acute Coronary Syndrome: A Cost-Effectiveness Analysis from the Chinese Healthcare Perspective.

PURPOSE: To assess the cost-effectiveness of evolocumab, a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, compared with ezetimibe, both added to background statin therapy in patients with recent acute coronary syndrome (ACS) events (in the past 12 months) and low-density lipoprotein cholesterol (LDL-C) levels ≥ 100 mg/dL in China. METHODS: A health economic evaluation was performed from a Chinese healthcare perspective, using a Markov model over a lifetime horizon based on a baseline cardiovascular (CV) event rate from claims database data and efficacy from the FOURIER trial. The health benefit was reflected in the decrease of LDL-C level, which led to a decrease of cardiovascular events. The costs of cardiovascular events and the utility value of each health state were derived from the published literature. Sensitivity analyses were conducted to evaluate the effects of uncertainty in parameters and the robustness of the model. The cost-effectiveness of evolocumab was also explored in patients with recent myocardial infarction (MI), at very high risk (VHR) of atherosclerotic cardiovascular disease (ASCVD), and homozygous familiar hypercholesterolemia (HoFH). RESULTS: In patients with recent ACS, evolocumab was associated with incremental quality-adjusted life-years (QALYs) of 1.33 and incremental costs of 115,782 yuan versus ezetimibe, both with background statin therapy, resulting in an incremental cost-effectiveness ratio (ICER) of 87,050 yuan per QALY gained. The probability of evolocumab + statins being cost-effective at a threshold of 217,341 yuan (three times per capita GDP, 2020), compared with ezetimibe + statins, was 100% in patients with recent ACS, recent MI, VHR ASCVD, and HoFH. CONCLUSION: Compared with ezetimibe + statins, the combination of evolocumab + statins was found to be cost-effective at a threshold of 217,341 yuan (three times per capita GDP, 2020) in patients with recent ACS events in China.

The anchor design of anchor-based method to determine the minimal clinically important difference: a systematic review.

BACKGROUND: Positive results for clinical outcomes should be not only statistically significant, but also clinically significant. The minimum clinically important difference (MCID) is used to define the minimum threshold of clinical significance. The anchor-based method is a classical method for ascertaining MCID. This study aimed to summarise the design of the anchors of the anchor-based method by reviewing the existing research and providing references and suggestions. METHOD: This study was mainly based on literature research. We performed a systematic search using Web of Science, PubMed, CNKI, Wanfang, and VIP databases. Two reviewers independently screened titles and abstracts to identify relevant articles. Data were extracted from eligible articles using a predefined data collection form. Discrepancies were resolved by discussion and the involvement of a third reviewer. RESULT: Three hundred and forty articles were retained for final analysis. For the design of anchors, Subjective anchors (99.12%) were the most common type of anchor used, mainly the Patient's rating of change or patient satisfaction (66.47%) and related scale health status evaluation items or scores (39.41%). Almost half of the studies (48.53%) did not assess the correlation test between the anchor and the research indicator or scale. The cut-off values and grouping were usually based on the choice of the anchor types. In addition, due to the large number of included studies, this study selected the most calculated SF-36 (28 articles) for an in-depth analysis. The results showed that the overall design of the anchor and the cut-off value were the same as above. The statistical methods used were mostly traditional (mean change, ROC). The MCID thresholds of these studies had a wide range (SF-36 PCS: 2-17.4, SF-36 MCS: 1.46-10.28), and different anchors or statistical methods lead to different results. CONCLUSION: It is of great importance to select several types of anchors and to use more reliable statistical methods to calculate the MCID. It is suggested that the order of selection of anchors should be: objective anchors > anchors with established MCID in subjective anchors (specific scale > generic scale) > ranked anchors in subjective anchors. The selection of internal anchors should be avoided, and anchors should be evaluated by a correlation test.

Measurement properties of the EQ-5D-5L in sub-health: evidence based on primary health care workers in China.

BACKGROUND: Sub-health which is the state between health and disease is a major global public health challenge. As a reversible stage, sub-health can work as a effective tool for the early detection or prevention of chronic disease. The EQ-5D-5L (5L) is a widely used, generic preference-based instrument while its validity in measuring sub-health is not clear. The aim of the study was thus to assess its measurement properties in individuals with sub-health in China. METHODS: The data used were from a nationwide cross-sectional survey conducted among primary health care workers who were selected on the basis of convenience and voluntariness. The questionnaire was composited of 5L, Sub-Health Measurement Scale V1.0 (SHMS V1.0), social-demographic characteristics and a question assessing the presence of disease. Missing values and ceiling effects of 5L were calculated. The convergent validity of 5L utility and VAS scores was tested by assessing their correlations with SHMS V1.0 using Spearman's correlation coefficient. The known-groups validity of 5L utility and VAS scores was assessed by comparing their values between subgroups defined by SHMS V1.0 scores using the Kruskal-Wallis test. We also did an analysis in subgroups according to different regions of China. RESULTS: A total of 2063 respondents were included in the analysis. No missing data were observed for the 5L dimensions and only one missing value was for the VAS score. 5L showed strong overall ceiling effects (71.1%). The ceiling effects were slightly weaker on the "pain/discomfort" (82.3%) and "anxiety/depression" (79.5%) dimensions compared with the other three dimensions (nearly 100%). The 5L weakly correlated with SHMS V1.0: the correlation coefficients were mainly between 0.2 and 0.3 for the two scores. 5L was yet not sensitive in distinguishing subgroups of respondents with different levels of sub-health, especially the subgroups with adjacent health status (p > 0.05). The results of subgroup analysis were generally consistent with those of the full sample. CONCLUSIONS: It appears that the measurement properties of EQ-5D-5L in individuals with sub-health are not satisfactory in China. We thus should be cautious to use it in the population.

Association of the availability of pharmaceutical facilities provided in secondary and tertiary hospitals with clinical pharmacists' work performance.

BACKGROUND: Clinical pharmacists always work as the pivotal role in the process of facilitating the proper use of drug. Based on the person-environment fit theory, the availability of facilities required in pharmaceutical service may influence pharmacists' performance, but which of them may have positive or negative impact remains unclear. OBJECTIVES: This study aims to analysed the quantitative association of the availability of pharmaceutical facilities provided in Chinese hospitals and clinical pharmacists' work performance to assist hospitals formulating plans of the improving pharmaceutical working conditions to enhance clinical pharmacists' performance. METHOD: Demonstrated by the panel of expert and literature review, the questionnaire for administrators and clinical pharmacists of secondary and tertiary hospitals in China was formed. Then a mixed sampling was adopted to gather data on information of the participants, as well as evaluation indexes of the availability of facilities and clinical pharmacists' work performance. RESULTS: Overall, 625 questionnaires distributed to administrators of hospitals and 1219 ones distributed to clinical pharmacists were retrieved. As for the Pharmaceutical facilities, while the increased availability of Traditional Chinese medicine pharmacy (p = 0.02) has a significantly positive impact on clinical pharmacists' performance, the great availability of the preparation room (p = 0.07) negatively influences their work performance. CONCLUSION: Improving the availability of facilities that significantly influence clinical pharmacists' work performance possibly reduce their workload, enhance their efficiency and further promote progress in pharmaceutical service.

Exploring the training of pharmacists oriented to the demands for clinical pharmacy services: from the perspective of physicians.

BACKGROUND: To evaluate physicians' perceptions, experiences and expectations of clinical pharmacists in China from the perspective of physicians' demands, to improve the training of pharmacists. METHODS: A cross-sectional survey involving physicians (except for primary physicians) was conducted from July to August 2019 in China. Using a field questionnaire, this study gathered data on descriptive information about the respondents and their perceptions, experiences and expectations of clinical pharmacists. Data were analysed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify physicians' demands for clinical pharmacists in China. RESULTS: A total of 1376 physicians from secondary and tertiary hospitals in China (response rate = 92%) participated. The majority of the respondents were comfortable with clinical pharmacists providing education to patients (59.09%) and detecting and preventing prescription errors (60.17%), but they appeared uncomfortable when asked about clinical pharmacists suggesting the use of prescription medications to patients (15.71%). Most respondents agreed that clinical pharmacists are a reliable source of general drug information (81.84%) instead of clinical drug information (79.58%). The majority of the respondents expected clinical pharmacists to be knowledgeable drug therapy experts (95.56%) and to educate their patients about the safe and appropriate use of medications (95.56%). CONCLUSION: Physicians' perceptions and experiences were positively associated with the frequency of their interaction with clinical pharmacists. They had high expectations of clinical pharmacists as knowledgeable drug therapy experts. Corresponding policies and measures are needed to improve the education and training system of clinical pharmacists in China.

[Guideline for clinical comprehensive evaluation of Chinese patent medicine (2022 version)].

Currently,the research or publications related to the clinical comprehensive evaluation of Chinese patent medicine are increasing,which attracts the broad attention of all circles. According to the completed clinical evaluation report on Chinese patent medicine,there are still practical problems and technical difficulties such as unclear responsibility of the evaluation organization,unclear evaluation subject,miscellaneous evaluation objects,and incomplete and nonstandard evaluation process. In terms of evaluation standards and specifications,there are different types of specifications or guidelines with different emphases issued by different academic groups or relevant institutions. The professional guideline is required to guide the standardized and efficient clinical comprehensive evaluation of Chinese patent medicine and further improve the authority and quality of evaluation. In combination with the characteristics of Chinese patent medicine and the latest research achievement at home and abroad,the detailed specifications were formulated from six aspects including design,theme selection,content and index,outcome,application and appraisal,and quality control. The guideline was developed based on the guideline development requirements of China Assoication of Chinese medicine. After several rounds of expert consensus and public consultation,the current version of the guideline has been developed.

The influence of non-clinical pharmacists' understanding of and attitudes towards pharmaceutical care on their willingness to serve as clinical pharmacists in China.

BACKGROUND: The shortage of clinical pharmacists is severe in China, and transferring non-clinical pharmacists into clinical pharmacists serves as a feasible solution to this problem. In China, a one-year training programme is available for non-clinical pharmacists, and those who have finished the programme are certificated as clinical pharmacists. However, not all non-clinical pharmacists are willing to serve as clinical pharmacists, and their willingness to serve as clinical pharmacists may be related to their attitudes towards pharmaceutical care. This study aims to test whether non-clinical pharmacists' attitudes towards pharmaceutical care is positively correlated with their willingness to serve as clinical pharmacists. METHODS: A cross-sectional survey was conducted in secondary and tertiary hospitals in China to collect non-clinical pharmacists' basic demographic information, attitudes towards pharmaceutical care and willingness to serve as clinical pharmacists. An ordered logistic regression analysis was performed to test the relationship between non-clinical pharmacists' attitudes towards pharmaceutical care and their willingness to serve as clinical pharmacists. RESULTS: One thousand five hundred eighty non-clinical pharmacists from 755 hospitals were invited to participate in the study. Finally, 1308 valid responses were obtained and the response rate reached 82.78%. The regression results (R2 = 0.052, chi-square = 174.024, p < 0.0001) suggested that attitudes towards pharmaceutical care had a positive impact on non-clinical pharmacists' willingness to serve as clinical pharmacists (p < 0.01). Control variables, such as age (p < 0.05), marital status (p < 0.05), professional title (p < 0.1), educational level (p < 0.1), salary expectations (p < 0.01) and experience providing pharmaceutical care (p < 0.01), also influenced non-clinical pharmacists' willingness to serve as clinical pharmacists. CONCLUSIONS: Based on the results, suggestions are made to increase non-clinical pharmacists' willingness to serve as clinical pharmacists.

Study of knowledge, attitude and practice regarding patient education in hypertension among community pharmacists in China.

BACKGROUND: In the prevention and treatment of hypertension, patient education is an important measure to improve the awareness rate and control rate of patients. The professional and geographical advantages of community pharmacists enable them to play an important role in the patient education in hypertension. The purpose of this study was to understand the situation of patient education in hypertension conducted in Chinese community pharmacies, and put forward measures according to the problems. METHODS: A multi-stage competitive sampling by convenience was used to select community pharmacists working in community pharmacies in China for the study. Based on KAP theory, the first draft of the questionnaire was designed and the Delphi method was used to improve the questionnaire and a pre-study was conducted to test the reliability of the questionnaire. In January 2020, electronic questionnaires were distributed to 143 community pharmacists in Chinese community pharmacies. SPSS24 software was used for descriptive statistics and subgroup analysis of data. RESULTS: One hundred and eight valid questionnaires were collected, and the efficiency rate was 75.5%. Most of the respondents were younger than 30 years old (98.1%), and had bachelor's degree (95.4%). In terms of knowledge, only 15.7% considered themselves "very good" and even 10.2% considered themselves "very bad". Only 35%-55% of respondents answered correctly for patient education content that requires more specialized knowledge, such as treatment and medication. Respondents generally had a positive attitude on the effect of hypertension patient education, but slightly less recognition of their role in patient education. In terms of practice, programs related to patient education have been conducted to different degrees. More than 30% of the community pharmacists interviewed implemented them occasionally or never. CONCLUSIONS: Despite a positive attitude, most of the respondents did not have a high level of knowledge or practice. In China, more research evidence and new guidelines are needed to emphasize the importance and responsibilities of community pharmacists. Continuing education should be certificated at the national level and meet the various needs of community pharmacists. And salary incentives can be tried to motivate them.

Association of education background with clinical pharmacists' clinical pharmacy workload in tertiary hospitals of China.

BACKGROUND: Workload of healthcare providers may affect the quality of healthcare. Practical evidences have indicated that healthcare providers are differentially associated with workload due to their different education and training background. Clinical pharmacists are an indispensable part of medical teams. Under the precondition that clinical pharmacists in China generally undertake uneven clinical pharmacy workload, the relationship of workload and clinical pharmacists' different education backgrounds remains unclear. This study aimed to assess the association between the education background of clinical pharmacists and their clinical pharmacy workload in China. METHODS: A field questionnaire survey using a stratified sampling was conducted to gather data on education background and clinical pharmacy workload through a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants' education background with their clinical pharmacy workload. RESULTS: A total of 625 clinical pharmacists from 311 tertiary hospitals in China participated. Two levels of education: less than bachelor's degree in general pharmacy, or doctoral degree in clinical pharmacy was associated significantly with clinical pharmacy workload of the participants. Participants who had credentials of national level and provincial-level specialized training for clinical pharmacists had undertaken more work than those without. Moreover, the participants' specialized field, such as respiratory medicine and nephrology, was associated with their clinical pharmacy workload. CONCLUSION: Enhancing several aspects of education or training among clinical pharmacists in tertiary hospitals in China may help improve their capability to provide clinical pharmacy services. Efforts are needed to improve the education and training system of clinical pharmacists in China.

Association of hospital pharmacy-related knowledge and skills with occupational stress of clinical pharmacists in tertiary hospitals of China.

OBJECTIVE: Occupational stress of health care providers may lower the quality of care. Person-environment fit theory and practical evidence have indicated that various types of knowledge and skills of health care providers are differentially associated with occupational stress. Clinical pharmacists are an indispensable part of medical teams. Clinical pharmacists in China are generally under high occupational stress, but what kind of knowledge and skills can relieve their occupational stress remains unclear. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. METHODS: A field questionnaire survey using a stratified sampling was conducted to gather data on occupational stress, knowledge and skills related to hospital pharmacy, and other factors of occupational stress using the Brief Job Stress Questionnaire and a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants' knowledge, skills, and other factors with their occupational stress. RESULTS: A total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Knowledge of or skills related to pharmaceutical care service provision (P = 0.02), the use of computers and the Internet in pharmacy practice (P = 0.02), interpersonal communication (P = 0.10), or pharmacoepidemiology (P = 0.08) was associated with reduced occupational stress of the participants. Participants who had credentials of nation-level specialized (P = 0.09) and general training (P = 0.04) for clinical pharmacist had lower degrees of occupational stress than those without these credentials. The participants' clinical professions, routine tasks, technical titles, and type of hospital they work in were also associated with their occupational stress. CONCLUSION: Enhancing several aspects of knowledge or skills among clinical pharmacists in tertiary hospitals in China may help reduce their occupational stress. Efforts are needed to improve the education and training system of clinical pharmacists in China.

The association between doctors' presenteeism and job burnout: a cross-sectional survey study in China.

BACKGROUND: It is necessary to examine doctors working with illness from a professional point of view, because it is not only related to their occupational health, but more importantly, will affect the treatment effect of patients and the overall medical level of the hospital. The purpose of this study was to explore the relationship between doctors' presenteeism and job burnout, and to identify other factors that are associated with presenteeism. METHODS: A cross-sectional survey involving doctors (except for primary doctors) was conducted in China. Using one item measure about presenteeism and a 15-item Chinese version of the BMI-GS questionnaire, this study investigated prevalence of doctors' presenteeism and job burnout, and determined the relationship between presenteeism and job burnout by logistical model. RESULTS: Relationship between presenteeism and job burnout were explored, and the influence of work factors were evaluated. The survey was completed by 1376/1547 hospital doctors, with a response rate of 88.9%. Presenteeism was reported by 30.7% of participants. Using MBI-GS, 86.8% of all doctors had moderate job burnout and 6.0%(n = 82) were severe job burnout. Logistic regression analysis showed that doctors with medium, high degree of emotional exhaustion and high degree of cynicism were more likely to practice presenteeism (all p < 0.05). In addition, two other work-related factors, including the doctors' department and position, were also likely to relate with presenteeism (all p < 0.05). CONCLUSIONS: By examining the relationship between presenteeism and job burnout, this study determined that there is indeed a significant correlation between the two. This result has a certain reference value for the development of work health, especially presenteeism and job burnout theory, and also makes a certain contribution to the relevant research literature.

Clinical and economic outcomes of hospital pharmaceutical care: a systematic review and meta-analysis.

BACKGROUND: Hospital clinical pharmacists have been working in many countries for many years and clinical pharmaceutical care have a positive effect on the recovery of patients. In order to evaluate the clinical effectiveness and economic outcomes of clinical pharmaceutical care, relevant clinical trial studies were reviewed and analysed. METHODS: Two researchers searched literatures published from January 1992 to October 2019, and screened them by keywords like pharmaceutical care, pharmaceutical services, pharmacist interventions, outcomes, effects, impact, etc. Then, duplicate literatures were removed and the titles, abstracts and texts were read to screen literatures according to inclusion and exclusion criteria. Key data in the literature were extracted, and Meta-analysis was conducted using the literature with common outcome indicators. RESULTS: A total of 3299 articles were retrieved, and 42 studies were finally included. Twelve of them were used for meta-analysis. Among the 42 studies included, the main results of pharmaceutical care showed positive effects, 36 experimental groups were significantly better than the control group, and the remaining 6 studies showed mixed or no effects. Meta-analysis showed that clinical pharmacists had significant effects on reducing systolic blood pressure and diastolic blood pressure and shortening hospitalization days (P < 0.05), but no statistical significance in reducing medical costs (P > 0.05). CONCLUSION: Clinical pharmacists' pharmaceutical care has a significant positive effect on patients' clinical effects, but has no significant economic effect.

Evaluation of the association between presenteeism and perceived availability of social support among hospital doctors in Zhejiang, China.

BACKGROUND: This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China. METHODS: A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis. RESULTS: The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences. CONCLUSION: In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors' presenteeism warrant further investigation.

Balancing Industry and Drug Policy Objectives in the Pharmaceutical Sector: The Case of China.

Objectives This article assessed the balance between industry and drug policy objectives in the pharmaceutical sector in China. Methods The articles were mainly identified through databases such as Elsevier, Google Scholar, and SpringerLink, among others. Related articles were mainly separated into three categories: studies on drug policies, studies related to China's new health-care reform policy, and studies concerning patent policies. Results A relatively healthy environment for continuous innovation and drug patent protection in the pharmaceutical industry has been created in China, and the public's drug benefits have also significantly improved. However, the balance between industrial and drug policy objectives in the pharmaceutical sector in China requires additional attention. Discussion and conclusions The results suggest that the government should pay more attention to incentivizing enterprises' innovation, but the current Essential Medicines System in China has limited innovation. Hence, the mechanism for selecting essential medicines should be reformed, and certain appropriate and reasonably innovative medicines should be included. Additionally, medicine coverage, especially the coverage of essential drugs for primary care should be expanded to improve public health benefits. Furthermore, the pharmaceutical industry should be incorporated into the prospective National Drug Policy to achieve a balance between public benefits and pharmaceutical industry development in the future.

A survey of the availability, prices and affordability of essential medicines in Jiangsu Province, China.

BACKGROUND: Field surveys conducted in China before the implementation of the essential medicine policy showed that Chinese individuals faced less access to essential medicines. This paper aims to evaluate the availability, prices and affordability of essential medicines in Jiangsu Province, China after the implementation of the policy in 2009. METHODS: A cross-sectional survey was conducted in Jiangsu in 2013 using the World Health Organization/Health Action International (WHO/HAI) methodology. Data on the availability and prices of 50 essential medicines were collected from the public and private healthcare sectors. RESULTS: The mean availabilities of innovator brands and lowest priced generics (LPGs) were 11.5% and 100% in primary healthcare facilities, 36.8% and 32.6% in the secondary and tertiary sectors, and 18.7% and 42.9% in the private sector, respectively. The median price ratios (MPRs) were 1.26 to 2.05 for generics and 3.76 to 27.22 for innovator brands. Treating ten common diseases with LPGs was generally affordable, whereas treatment with IBs was less affordable. CONCLUSIONS: The high availability of LPGs at primary healthcare facilities reflects the success of the essential medicine policy, while the low availability in secondary and tertiary levels and in private pharmacies reflects a failure to implement the policy in these levels. The health policy should be fully developed and enforced at the secondary and tertiary levels and in the private sector to ensure equitable access to health services.

Study of non-spherical bubble oscillations near a surface in a weak acoustic standing wave field.

The interaction of acoustically driven bubbles with a wall is important in many applications of ultrasound and cavitation, as the close boundary can severely alter the bubble dynamics. In this paper, the non-spherical surface oscillations of bubbles near a surface in a weak acoustic standing wave field are investigated experimentally and numerically. The translation, the volume, and surface mode oscillations of bubbles near a flat glass surface were observed by a high speed camera in a standing wave cell at 46.8 kHz. The model approach is based on a modified Keller-Miksis equation coupled to surface mode amplitude equations in the first order, and to the translation equations. Modifications are introduced due to the adjacent wall. It was found that a bubble's oscillation mode can change in the presence of the wall, as compared to the bubble in the bulk liquid. In particular, the wall shifts the instability pressure thresholds to smaller driving frequencies for fixed bubble equilibrium radii, or to smaller equilibrium radii for fixed excitation frequency. This can destabilize otherwise spherical bubbles, or stabilize bubbles undergoing surface oscillations in the bulk. The bubble dynamics observed in experiment demonstrated the same trend as the theoretical results.