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.

     

生物等效性试验中受试者食用高脂餐的调查研究

目的评价餐后生物等效性试验中受试者食用高脂餐的情况,总结高脂餐食谱制订的考虑因素。方法对完成首都医科大学附属北京朝阳医院Ⅰ期临床试验研究室(以下简称"本中心")两周期、双交叉、餐后生物等效性试验的33例健康受试者的高脂餐食谱、就餐时间、进食量进行分析,对食用西式高脂餐的21例受试者进行就餐感受的问卷调查,调查内容包括食用高脂餐的感受、餐后饱腹感、餐后有无不适、对于中西式高脂餐的选择和对西式高脂餐中接受度不高的成分。结果本中心选择的中式、西式高脂餐对于受试者的进食量均无影响;57. 14%的受试者倾向于食用西式高脂餐,42. 86%的受试者倾向于食用中式高脂餐;西式高脂餐中接受度不高的成分主要有黄油(33. 33%)、纯牛奶(14. 29%)、沙拉酱(14. 29%)、美式培根(9. 52%)。结论本中心选择的中西式高脂餐基本满足试验需要。综合考虑指导原则要求、受试者就餐感受、避免接受度不高的食物成分等因素,制订更为合理的高脂餐食谱,从而提高临床试验质量。     

Rapamycin attenuates Tc1 and Tc17 cell responses in cigarette smoke-induced emphysema in mice

Inflammation Research - Chronic exposure to cigarette smoke promotes airway inflammation and emphysema accompanied by enhanced CD8+ interferon (IFN)-γ+ T(Tc1) and CD8+ interleukin (IL)-17+...     

Population pharmacokinetics of theophylline in adult Chinese patients with asthma and chronic obstructive pulmonary disease

Background Theophylline has a narrow therapeutic range and large interindividual variability in blood levels, so a thorough understanding of its pharmacokinetic characteristics is essential. Population pharmacokinetic (PPK) approaches could achieve it and many PPK studies of theophylline have been reported in infants. However, none was conducted in Chinese adults and none has explored the effect of CYP1A2 genotypes on the PPK characteristics of theophylline in adults. Objective To evaluate the PPK characteristics of theophylline and to assess the possible influence of covariates, including CYP1A2 genotypes, on theophylline clearance in Chinese adult patients. Setting The study is conducted at the department of respiration in Zhujiang Hospital, Guangzhou, China. Methods Theophylline concentrations were obtained from eligible patients and were measured by high performance liquid chromatography. The polymorphisms of ??3860G?>?A, ??163C?>?A, C5347T (CYP1A2*1B) and G-3113A were genotyped using a direct sequencing method. Then, CYP1A2 genotypes, age, fat-free mass (FFM) and other covariates were used to develop a PPK model by NONMEM software. Bootstrap analysis was used to asses the accuracy and prediction of the PPK model. Main outcome measure The concentration and clearance of theophylline. Results A total of 134 theophylline concentrations from 95 patients were obtained. The final model was as follows: CL/F(L/h)?=?4.530?×?(FFM/56.1)^0.75 ×?0.713^CYP1A2*1B, the inter-individual variability in clearance/bioavailability (CL/F) was 44.0%, and the residual variability was 9.8%. The final model was proved to be reliable by bootstrap analysis. Conclusion Theophylline clearance was significantly associated with FFM and CYP1A2*1B genotypes in Chinese adult patients.     

HPLC-MS/MS同时测定广金钱草中8种成分在大鼠胆汁中的浓度及其排泄动力学研究

建立同时测定灌胃给予大鼠广金钱草提取物后胆汁中7种黄酮和1种酚酸类化合物浓度的HPLC-MS/MS,并用于胆汁排泄研究。大鼠灌胃给予广金钱草提取物后,分别在0~1,1~2,2~4,4~6,6~8,8~12,12~24 h时间段收集胆汁。色谱柱采用Diamonsil C18column(4.6 mm×150 mm,5μm),柱温40℃。以甲醇-0.01%乙酸水溶液为流动相,梯度洗脱,流速0.8 m L·min~(-1)。质谱采用电喷雾离子源(ESI),负离子模式下检测,多反应离子监测(MRM)模式进行定量。结果表明8种成分在测定浓度范围内线性关系良好(r≥0.991 5),日内、日间精密度RSD15%,准确度RE-15%~15%,稳定性良好。提取回收率63.2%,内标归一化的基质因子RSD均未超过15%,符合要求。大鼠胆汁排泄研究结果显示,8种成分在胆汁中的原型排泄率均比较小,并且不同个体之间差别较大。该研究方法灵敏度高,选择性好,样品处理简单,可用于灌胃给予大鼠广金钱草提取物后胆汁中8种成分的排泄动力学研究。     

白色念珠菌黏附相关受体及基因的研究

白色念珠菌又称白假丝酵母菌，是人体常驻菌，是一种条件致病菌。它可引起浅表或深部的白色念珠菌病。在致病过程中，其黏附是第一步，也是最关键的一步。因此，明确其黏附相关机制，对预防及控制白色念珠菌病具有重要意义。