OBJECTIVE To investigate the relationship between nurse-to-patient ratios and hospital-acquired infec-tions(HAIs)in the intensive care units,and to assess the impact of both average and maximum nurse-to-patient ratios on the risk of HAIs.METHODS Data were obtained from the hospital information system(including Hospi-tal Information System,nursing sensitive quality indicator monitoring system and hospital infection management system).Inpatients aged 18 years and older in ten intensive care units from 1 Jan.2022 to 31 Dec.2023 were in-cluded;data on the nurse-to-patient ratios during day shifts,night shifts and the overall period and HAIs cases were collected.Univariate test was conducted to compare differences between the infection group and the non-infection group.Logistic regression models were utilized to evaluate the association between various nurse-to-patient ratio indicators and the risk of HAIs while controlling the covariates.RESULTS A total of 2 742 patients were included,with an HAIs incidence rate of 18.23％.The average patient-to-nurse ratio was significantly low-er in the infection group than in the non-infection group(2.76±0.82 vs.3.27±1.16,P＜0.001),whereas the maximum nurse-to-patient ratios for the overall period,day and night shifts were 3.57±1.09(infected)vs.3.91±1.31(uninfected),3.30±1.12 vs.3.48±1.16,and 4.62±1.85 vs.5.10±2.08,respectively(all P＜0.001).Regression analysis showed that no significant association between the average nurse-to-patient ratios for the overall period,day and night shifts and the risk of HAIs;whereas the odds ratios(ORs)for the maximum patient-to-nurse ratio greater than 4 were 2.122(1.355-3.324)for the overall period,2.061(1.333-3.186)for the day shift and 1.495(1.055-2.118)for the night shifts(all nurse-to-patient ratios≤3 in the reference group).CONCLUSIONS The maximum nurse-to-patient ratios are important risk factors for HAIs in the intensive care u-nits,whereas the average nurse-to-patient ratios are not significantly associated with HAIs.It is suggested that in-sufficient nursing resources during peak hours may increase the risk of infection,and optimizing the allocation of nursing care during peak hours will help to reduce the incidence of HAIs.

Objective:To develop an intelligent surveillance system for identifying upper gastrointestinal high-risk patients and assigning surveillance intervals, and to verify its efficacy.Methods:The endoscopic and pathological reports of 23 035 patients undergoing endoscopy at Renmin Hospital of Wuhan University from January to October 2021 were collected retrospectively. A training set of 17 934 patients (January to August) and a test set of 5 101 patients (September to October) were established. Keywords in the endoscopic and pathological reports were extracted by the intelligent surveillance system, and high-risk patients were automatically identified and classified into 7 risk levels. Then the standardized surveillance intervals were assigned based on the guideline. Guideline-based surveillance intervals assigned by expert endoscopists based on endoscopic and pathological reports were used as the golden standard. The accuracy of the intelligent surveillance system was calculated. Of the patients within the test set, 189 were hospitalized and the surveillance intervals given by physicians could be obtained from the electronic health records. The accuracy of the intelligent surveillance system with that of physicians from different departments was compared. Then 67 patients were randomly selected from 189 patients by simple random sampling to evaluate the adjunctive effect of the system in assigning surveillance intervals among 3 endoscopists.Results:The overall accuracy of the intelligent surveillance system in identifying upper gastrointestinal high-risk patients was 99.94% (5 098/5 101), and that of assigning surveillance intervals to correctly included patients was 100.00% (534/534). The intelligent surveillance system achieved significantly higher accuracy compared with all physicians from different departments [98.94% (187/189) VS 35.45% (67/189), χ2=118.01, P<0.001] as well as physicians from department of gastroenterology [100.00% (117/117) VS 24.79% (29/117), χ2=86.01, P<0.001]. With the assistance of the intelligent surveillance system, the endoscopists' accuracy of assigning surveillance intervals to 67 patients was significantly improved [55.22% (111/201) VS 22.39% (45/201), χ2=58.68, P<0.001]. Conclusion:The intelligent surveillance system can accurately identify upper gastrointestinal high-risk patients and assign surveillance intervals according to risk levels, which can alleviate the workload of doctors and improve the follow-up rate of patients.

OBJECTIVE To investigate the relationship between nurse-to-patient ratios and hospital-acquired infec-tions(HAIs)in the intensive care units,and to assess the impact of both average and maximum nurse-to-patient ratios on the risk of HAIs.METHODS Data were obtained from the hospital information system(including Hospi-tal Information System,nursing sensitive quality indicator monitoring system and hospital infection management system).Inpatients aged 18 years and older in ten intensive care units from 1 Jan.2022 to 31 Dec.2023 were in-cluded;data on the nurse-to-patient ratios during day shifts,night shifts and the overall period and HAIs cases were collected.Univariate test was conducted to compare differences between the infection group and the non-infection group.Logistic regression models were utilized to evaluate the association between various nurse-to-patient ratio indicators and the risk of HAIs while controlling the covariates.RESULTS A total of 2 742 patients were included,with an HAIs incidence rate of 18.23％.The average patient-to-nurse ratio was significantly low-er in the infection group than in the non-infection group(2.76±0.82 vs.3.27±1.16,P＜0.001),whereas the maximum nurse-to-patient ratios for the overall period,day and night shifts were 3.57±1.09(infected)vs.3.91±1.31(uninfected),3.30±1.12 vs.3.48±1.16,and 4.62±1.85 vs.5.10±2.08,respectively(all P＜0.001).Regression analysis showed that no significant association between the average nurse-to-patient ratios for the overall period,day and night shifts and the risk of HAIs;whereas the odds ratios(ORs)for the maximum patient-to-nurse ratio greater than 4 were 2.122(1.355-3.324)for the overall period,2.061(1.333-3.186)for the day shift and 1.495(1.055-2.118)for the night shifts(all nurse-to-patient ratios≤3 in the reference group).CONCLUSIONS The maximum nurse-to-patient ratios are important risk factors for HAIs in the intensive care u-nits,whereas the average nurse-to-patient ratios are not significantly associated with HAIs.It is suggested that in-sufficient nursing resources during peak hours may increase the risk of infection,and optimizing the allocation of nursing care during peak hours will help to reduce the incidence of HAIs.

Objective:To develop an intelligent surveillance system for identifying upper gastrointestinal high-risk patients and assigning surveillance intervals, and to verify its efficacy.Methods:The endoscopic and pathological reports of 23 035 patients undergoing endoscopy at Renmin Hospital of Wuhan University from January to October 2021 were collected retrospectively. A training set of 17 934 patients (January to August) and a test set of 5 101 patients (September to October) were established. Keywords in the endoscopic and pathological reports were extracted by the intelligent surveillance system, and high-risk patients were automatically identified and classified into 7 risk levels. Then the standardized surveillance intervals were assigned based on the guideline. Guideline-based surveillance intervals assigned by expert endoscopists based on endoscopic and pathological reports were used as the golden standard. The accuracy of the intelligent surveillance system was calculated. Of the patients within the test set, 189 were hospitalized and the surveillance intervals given by physicians could be obtained from the electronic health records. The accuracy of the intelligent surveillance system with that of physicians from different departments was compared. Then 67 patients were randomly selected from 189 patients by simple random sampling to evaluate the adjunctive effect of the system in assigning surveillance intervals among 3 endoscopists.Results:The overall accuracy of the intelligent surveillance system in identifying upper gastrointestinal high-risk patients was 99.94% (5 098/5 101), and that of assigning surveillance intervals to correctly included patients was 100.00% (534/534). The intelligent surveillance system achieved significantly higher accuracy compared with all physicians from different departments [98.94% (187/189) VS 35.45% (67/189), χ2=118.01, P<0.001] as well as physicians from department of gastroenterology [100.00% (117/117) VS 24.79% (29/117), χ2=86.01, P<0.001]. With the assistance of the intelligent surveillance system, the endoscopists' accuracy of assigning surveillance intervals to 67 patients was significantly improved [55.22% (111/201) VS 22.39% (45/201), χ2=58.68, P<0.001]. Conclusion:The intelligent surveillance system can accurately identify upper gastrointestinal high-risk patients and assign surveillance intervals according to risk levels, which can alleviate the workload of doctors and improve the follow-up rate of patients.

Objective: To evaluate the cost-effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China. Methods: A static life-time Markov model is conducted to simulate the Chinese elderly population aged ≥60 years old. Taking the health care system perspective, one-year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality-adjusted life year (QALY) (193 932/QALY), the incremental cost-effectiveness ratio (ICER) was calculated to compare the cost-effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output. Results: The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. Conclusion Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost-effective compared to no vaccination in elderly Chinese population.

Objective To evaluate the cost?effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China. Methods A static life?time Markov model is conducted to simulate the Chinese elderly population aged≥60 years old. Taking the health care system perspective, one?year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality?adjusted life year (QALY) (193 932/QALY), the incremental cost?effectiveness ratio (ICER) was calculated to compare the cost?effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One?way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output. Results The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. Conclusion Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost?effective compared to no vaccination in elderly Chinese population.

Objective To evaluate the cost?effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China. Methods A static life?time Markov model is conducted to simulate the Chinese elderly population aged≥60 years old. Taking the health care system perspective, one?year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality?adjusted life year (QALY) (193 932/QALY), the incremental cost?effectiveness ratio (ICER) was calculated to compare the cost?effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One?way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output. Results The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. Conclusion Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost?effective compared to no vaccination in elderly Chinese population.

OBJECTIVE:To investigate the effectiveness and economy of Xinmailong injection combined with basic treatment plan in the treatment of heart failure with reduced left ventricular ejection fraction (HFREF).METHODS:In prospective randomized central group and open programmatic clinical trials,HFREF patients enrolled in 27 general hospitals during Feb.2014-Nov.2016 were divided into control group (n=253) and trial group (n=872) according to 1∶3.Control group received basic treatment,while trial group was additionally given Xinmailong injection intravenously for a treatment course (5 d) at least.Cost-effectiveness analysis was conducted from the perspective of the whole society by using the total response rate of cardiac functional grading,left ventricular ejection fraction (LVEF) improved data,Minnesota heart failure quality scale (MLHFQ) improved data and re-hospitalization rate.RESULTS:Total response rates of cardiac functional grading in control group and trial group were 61.54％ and 81.06％ in 3 months.The improved data of LVEF were about 3.05％ and 7.35％;MLHFQ improved data were 24.39 and 26.63,and re-hospitalization rates were 19.43％ and 10.02％.There were statistical significance in 2 groups (P＜0.05),which indicated that clinical efficacy of trial group was better than that of control group.Pharmacoeconomics results showed that cost-effectiveness ratio of positive indicators as the improved data of LVEF and chronic cardiac insufficiency QOL scale (MLHFQ) in trial group were lower than control group (189.35 vs.243.46,576.38 vs.614.29).The cost-effectiveness ratio of re-hospitalization rate and fatality rate in trial group were higher than control group (2 019.61 vs.925.42).CONCLUSIONS:Xinmailong injection combined with basic treatment plan is better than basic treatment plan in the treatment of HFREF,and shows a better economy in cost-effectiveness analysis.

Object:The paper aims to analyze Taiwanese experience in pharmaceutical procurement, pharma-ceutical benefits and reimbursement schedule, and make references for the Mainland China. Methods:Through read-ing and analyzing the Taiwanese government policy and the literature published to find out the pharmaceutical pro-curement measures, different medicines’ pricing strategy and its reimbursement mode compared with the Mainland China. Results: Hospitals can purchase medicines based on their own needs, and the purchase price was formed through negotiating with providers and buyers. It has been found that Taiwan only controls the medicines reimburse-ment prices. The international reference pricing is adopted for new medicines, and the originators, bioequivalence/bioavailability generic medicines and general generics reimbursement prices are very high at international reference prices, and need to be weakened in order to fit the requirements. Moreover, the medicine quality is one of the stand-ards considered in case of making decisions on the reimbursement prices. In addition, the reimbursement price is as-sociated with procurement price. When the spread is larger than 30%, the government will adjust the reimbursement to fill the gap. Conclusions: Through the system design and adjustment, the Taiwanese Government have set up a better procurement and reimbursement co-ordination in the pharmaceutical segment, and formed the reasonable prices for the case. The Taiwanese experience can be taken as a reference for the mainland China to refine its procurement reforms and reimbursement policy.

Recombinant activated factor VII (rFVIIa) is a novel therapeutic agent for life-threatening massive gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding in a 78-year-old female patient with respiratory and renal failure. After failure of management of the bleeding with routine pharmacotherapy, we gave the patient rFVIIa injection at the dose of 20 µg/kg and the bleeding was rapidly controlled. Adverse side effects of the drug were not observed in this patient.
Aged ; Factor VIIa ; therapeutic use ; Female ; Gastrointestinal Hemorrhage ; drug therapy ; Humans ; Recombinant Proteins ; therapeutic use ; Renal Insufficiency ; Respiratory Insufficiency