Trace and evaluation systems for health services quality in rural and remote areas: a systematic review

Aim

To provide a systematic review of the existing theory, framework, systems and instruments for tracing and evaluating quality in rural health services.

Subjects and methods

We searched six electronic databases up to March 2016. Observational studies of quality assessment of rural health services using theoretical models were included. Ekman’s scale was used to evaluate the quality of the included studies.

Results

A total of 18 studies, published between 2001 and 2015, met the inclusion criteria. The corresponding authors for most of them (7, 44%) are from Chinese institutions and three (3, 17%) from Australian institutions. Five studies (28%) focused on township hospitals. Primary health care quality was reported in five studies (28%), followed by clinical service in four (22%). More than half of the studies (61%) were considered of high quality, and the remainder was of moderate quality. These studies applied 16 theoretical systems, including the model/pattern (4, 25%), method/tool (7, 44%) and framework of the theory (5, 31%). Most of the theoretical models (14, 88%) obtained positive observations. In addition, the conceptual model (6, 36%) and TOPSIS method (2, 13%) were more frequently reported.

Conclusion

Although most of the current studies were considered to have high-quality and positive results, there were limitations in the number of publications and research on theoretical systems. The lacks of unified standards and comprehensive evaluation are important issues that need to be pointed out and resolved.

     

G-CSF-Mobilized Blood and Bone Marrow Grafts as the Source of Stem Cells for HLA-Identical Sibling Transplantation in Patients with Thalassemia Major

As an inherited anemia, thalassemia major (TM) is currently only curable with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Here we report an allo-HSCT protocol for patients with TM who received a combination of granulocyte colony-stimulating factor-primed bone marrow and peripheral blood stem cells (G-BM & PBSCs) from a matched sibling donor (MSD). The conditioning regimen consisted of i.v. busulfan, cyclophosphamide, fludarabine, and antithymocyte globulin. Chimerism analysis was performed for all patients. Immunosuppressive treatment was terminated if rejection was suspected, and donor lymphocyte infusion was administered once no response was observed. A total of 184 patients with TM were enrolled in the study between July 2007 and July 2018. The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 13.1%, and that of moderate or severe chronic GVHD was 5.7%. The cumulative incidence of graft rejection was .6%. In the total cohort, the 3-year overall survival, thalassemia-free survival, and GVHD-free, relapse-free survival were 97.8%, 97.3%, and 89.5%, respectively. Collectively, our results indicate that G-BM & PBSCs from an MSD is be a good stem cell source for patients with TM undergoing allo-HSCT.     

Chloride channel 3 (CIC-3) predicts the tumor size in hepatocarcinoma

Chloride channel 3 (CIC-3) has been suggested to be implicated in the carcinogenesis though; it still remains ill understood in hepatocarcinoma, especially in terms of clinicopathological meaning of its expression. Given this, herein, to understand the clinicopathological significance of CIC-3 expression in hepatocarcinoma, Immunohistochemistry was performed to examine the level of CIC-3, followed by statistical analysis of the correlation between expression versus clinicopathological variables, including gender, age, TNM classifications, tumor size, lymph node metastasis and overall prognosis. It was shown that positive staining of CIC-3 can be present in both hepatocarcinoma and its paired normal controls; and that CIC-3 was significantly over-expressed in hepatcarcioma on the whole relative to paired normal controls. Moreover, up-regulation of CIC-3 markedly correlated with tumor size and overall prognosis, suggesting that CIC-3 expression could predict both tumor size and overall prognosis in hepatocarcinoma.     

两款糖化血红蛋白床旁分析仪的正确性评价

目的借助二级参考测量程序(SRMP),探讨两款床旁(point-of-care testing,POCT)糖化血红蛋白(HbA1c)分析仪的正确性。方法依据美国临床和实验室标准化协会(CLSI)Ep9-A2选取40份临床EDTA抗凝静脉全血样本,用比对的方式,分别评价两款POCT HbA1c分析仪与SRMP间的偏倚。结果POCT-1和POCT-2相关方程分别为,Y=1.0424X-0.3144和Y=1.0054X-0.2242相关系数(r)分别为0.9959和0.9469。临床各诊断切点处,偏倚小于美国国家糖化血红蛋白标准化计划(NGSP)和美国病理家协会(CAP)的要求(±6%)。结论两款POCTHbA1c分析仪与溯源到IFCC参考方法的SRMP比对具有良好的正确性,可以满足临床使用。