1.Characteristics of Emergency Health Systems Guidance Based on AGREE-HS
Danping ZHENG ; Wei YANG ; Nannan SHI ; Dongfeng WEI ; An LI ; Gezhi ZHANG ; Xue CHEN ; Fangqi LIU ; Zhaoshuai YAN ; Weixuan BAI ; Xinghua XIANG ; Yaxin TIAN ; Mengyu LIU ; Huamin ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(22):137-148
This study used the Appraisal of Guidelines Research & Evaluation-Health Systems (AGREE-HS) to demonstratively compare 34 global coronavirus disease-2019 (COVID-19) health systems guidance documents (HSGs) and 6 World Health Organization (WHO) standard HSGs. The comparison involved topic, participants, methods, recommendations, and implementability, with the aim of exploring the characteristics of emergency HSGs. The results showed that the emergency HSGs had an overall average score of 49%, with topic having the highest score, recommendations having the second highest score, and participants having the lowest score. The standard HSGs had an overall average score of 79%, with high scores in all items. The emergency HSGs had lower scores in participants, methods, recommendations, and implementability than the standard HSGs (P<0.001), while the COVID-19 emergency HSGs developed by the WHO had higher score in topic than the standard HSGs (P<0.05). Compared with those released by countries, the COVID-19 emergency HSG developed by the WHO showed superiority in all items and overall scores (P=0.000 2). This indicates that emergency HSGs, represented by the COVID-19 emergency HSG, place equal emphasis on topic and recommendations as standard HSGs but have low requirements in terms of expert participation, evidence support, and comprehensive consideration in the time- and resource-limited context. They have the characteristics of prominent topics, clear purposes, orientation to demand, keeping up with the latest evidence, flexible adjustment, and timeliness, emphasizing immediate implementation effects, weakening long-term effects, and focusing on comprehensive benefits. Additionally, developers, types, and report completeness are important influencing factors.
2.Characteristics of Developing Methods for Emergency Health Systems Guidance Based on AGREE-HS
Danping ZHENG ; Wei YANG ; Dongfeng WEI ; Nannan SHI ; Lin TONG ; An LI ; Gezhi ZHANG ; Xue CHEN ; Fangqi LIU ; Weixuan BAI ; Xinghua XIANG ; Mengyu LIU ; Huamin ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(22):149-156
The scientific rigor and efficacy of methodologies employed in drafting emergency health systems guidance documents (HSGs) are paramount in guaranteeing the quality, reliability, and applicability of HSGs. According to the Appraisal of Guidelines for Research and Evaluation- Health Systems (AGREE-HS), we demonstratively assessed both global coronavirus disease-2019 (COVID-19) emergency HSGs and World Health Organization (WHO) standard HSGs to uncover the core attributes of methods employed in the development of emergency HSGs. Our evaluation findings revealed that across the five assessment items of AGREE-HS, methods in the 34 emergency HSGs evaluated ranked third, trailing behind topic and recommendations. Notably, criterion 2 (the best available and most contextually relevant evidence is considered) received the highest score, whereas criterion 5 (evidence of cost and cost-effectiveness of the potential options is described) scored the lowest. Compared with the WHO standard HSGs, the COVID-19 emergency HSGs exhibited low scores in methods (P<0.05), which was reflected in nine criteria (P<0.05), especially in criteria 1 (systematic and transparent methods are used to identify and review the evidence) and 9 (systematic and transparent methods are used to agree upon the final recommendations). Among the COVID-19 emergency HSGs, that developed by the WHO achieved higher scores in eight out of all nine criteria, excluding criterion 8 (P<0.05). The clinically relevant emergency HSGs had higher scores in the criteria 3 (the evidence base is current) and 8 (the rationale behind the recommendations is clear) than other types of emergency HSGs. Collectively, the methodology for developing emergency HSGs, represented by the COVID-19 emergency HSG, underscores evidence orientation and integrates expert consensus. It is characterized by adaptable evidence synthesis strategies, streamlined evidence review protocols, and contextual relevance, all of which are influenced by external, internal, and implementation-specific factors.
3.Characteristics of Participants for Developing Emergency Health Systems Guidance Based on AGREE-HS
An LI ; Gezhi ZHANG ; Xue CHEN ; Fangqi LIU ; Danping ZHENG ; Weixuan BAI ; Wei YANG ; Dongfeng WEI ; Nannan SHI ; Mengyu LIU
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(22):157-163
The formulation method of emergency health systems guidance (HSG) is crucial, directly impacting the efficiency and effectiveness of responses in emergencies. A scientifically sound, systematic, and easily executable guidance document can assist health institutions at all levels in quickly coordinating resources, standardizing emergency response processes, and safeguarding public health. This study employed the Appraisal of Guidelines for Research and Evaluation for Health Systems (AGREE-HS) to analyze the characteristics of participants in developing emergency HSGs represented by the COVID-19 emergency HSG. The results showed that in the 34 HSGs included in this study, the item participants received the lowest score. Within this item, criterion 1 (diversity of development group) scored the highest (3.13±1.55), while criterion 5 (prevention of funding agency influence) scored the lowest (1.21±0.47). There were differences (P<0.05) in measures taken to mitigate funding agency influence between the six standard HSGs developed by the World Health Organization (WHO) and the four emergency HSGs. Additionally, differences (P<0.05) existed in the development group members, background, conflicts of interest, and preventive measures between the six WHO standard HSGs and the 34 emergency HSGs, as well as between the HSGs developed by the WHO and those developed by countries. The participants in developing emergency HSGs were influenced by various factors, including limited time for guideline development, modes of participation, scarce evidence, and uncertainties in expected outcomes. There is a need to downplay extensive requirements concerning the composition of group members, institutional diversity, and conflicts of interest, emphasizing the roles of key participants like government officials and professionals who can provide rapid, practical guidance in emergency situations.
4.Characteristics of Implementability of Emergency Health Systems Guidance Based on AGREE-HS
Fangqi LIU ; Mengyu LIU ; Danping ZHENG ; An LI ; Xue CHEN ; Gezhi ZHANG ; Dongfeng WEI ; Wei YANG ; Weixuan BAI ; Yong LI
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(24):250-256
Guidance implementation acts as a bridge between theory and practice,enabling the rapid expansion of their impact and application. This study demonstratively evaluated emergency health systems guidance documents (HSG),represented by the COVID-19 emergency HSG,based on the item implementability of the Appraisal of Guidelines for Research and Evaluation-Health Systems (AGREE-HS),aiming to explore the characteristics of implementability in emergency HSG. The evaluation results indicated that the COVID-19 emergency HSG had a low mean score in implementability,which ranked just above the item participants. Criterion 2 (costs and resource considerations for implementing the recommendations) received the highest mean score of 4.29,while criterion 9 (systematic evaluation of implementation) received the lowest mean score of 1.34. The emergency HSG formulated by the World Health Organization(WHO) and those formulated by various countries showed no difference (P=0.114) in criterion 1 (barriers and facilitators to implementation) but had differences (P<0.05) regarding the average item scores and the scores of the remaining criteria. The WHO standard HSG had high overall scores and had differences (P<0.05) in both the mean item scores and the scores of the nine criteria when compared with the emergency HSG. The global/national HSG showed differences in scores of criterion 1 (barriers and facilitators to implementation) compared with the both clinically relevant HSG and material support HSG (P<0.05). Emergency HSG prioritized considerations of implementation costs,resources,and flexibility in terms of implementability,while de-emphasizing aspects such as stakeholder opinions,dissemination strategies,and evaluation of HSG. This may be attributed to the context in which emergency HSG are formulated,given the inherent flexibility and variability of emergency health events. The developers should comprehensively consider the needs and characteristics related to the implementability of emergency HSG during the formulation process.
5.The application value and predictors of 18F-PSMA PET/CT on the metastatic lesions of prostate cancer with tPSA≤20 ng/mL
Anqi ZHENG ; Zhuonan WANG ; Weixuan DONG ; Yunxuan LI ; Lei LI ; Dalin HE ; Kaijie WU ; Xiaoyi DUAN
Journal of Modern Urology 2024;29(1):23-28
【Objective】 To explore the application value of 18F-PSMA PET/CT on the detection of metastatic lesions of prostate cancer with serum total prostate specific antigen (tPSA) ≤20 ng/mL and the predictive variables affecting the imaging results, and to establish a predictive nomogram for the metastasis of prostate cancer. 【Methods】 The imaging, pathological, serum and clinical data of 175 pathologically confirmed prostate cancer patients who underwent 18F-PSMA PET/CT examination during Jan.2020 and Oct.2021 were retrospectively collected.The patients were divided into metastatic group and non-metastatic group according to PET/CT imaging results, and the positive detection rate of metastatic lesions was calculated.The independent influencing factors of 18F-PSMA PET/CT in the positive detection of metastatic lesions were determined with univariate and multivariate logistic regression analyses.The predictive nomogram was established. 【Results】 Of the 175 patients, metastatic lesions were detected in 78 cases and not detected in 97 cases, with a detection rate of 44.6% (78/175).There were statistically significant differences between the metastatic group and the non-metastatic group in urinary tract symptoms, androgen deprivation treatment (ADT) at the time of PET/CT examination and the risk level of Gleason score (GS) (P<0.05).Univariate logistic regression showed that urinary tract symptoms(OR=3.64, P<0.001), GS risk (OR=3.96, P<0.001) and concurrent ADT treatment (OR=3.71, P<0.001) were associated with the positive detection rate of metastatic lesions.Multivariate Logistic regression showed that urinary tract symptoms (OR=3.19, P=0.002), GS high-risk group (OR=2.95, P=0.005) and concurrent ADT treatment (OR=3.27, P=0.001) were independent predictors of positive detection rate. 【Conclusion】 The probability of metastasis in newly diagnosed prostate cancer patients with tPSA≤20 ng/mL is high.18F-PSMA PET/CT is of high value for the early detection of metastasis.Urinary tract symptoms, GS high-risk group and concurrent ADT treatment are independent predictors of metastatic lesions.The predictive nomogram can help assist clinical optimization of imaging examination path.
6.KAP Survey on Medication Among AIDS Patients in a 3A-grade Hospital of Guangzhou
Yuyan LUO ; Yunfei XIAO ; Zilin ZHENG ; Yaxi LI ; Jiayi MA ; Yifang WENG ; Weixuan ZHENG ; Zhanlian HUANG
Journal of Sun Yat-sen University(Medical Sciences) 2024;45(5):728-738
[Objective]To evaluate the knowledge,attitude and practice(KAP)of medication use and safety among the patients with acquired immune deficiency syndrome(AIDS)in a 3A-grade hospital of Guangzhou city,and to provide scientific basis for AIDS prevention and treatment.[Methods]A questionnaire survey was conducted among AIDS patients aged 18 years and above in our hospital to investigate their KAP regarding medication use and safety.[Results]A total of 549 questionnaires were collected,of which 503 were valid,with an effective recovery rate of 91.6%.The average scores of KAP were(14.58±8.49),(25.21±6.92)and(47.58±3.33),respectively,with the scoring rates of 36.46%,63.02%,and 95.16%,respectively.There were statistically significant differences(P<0.05)in knowledge scores among people with different ages,education levels and occupations.Multiple linear regression showed that education level and medical insurance status had most significant impact on knowledge scores(P<0.05).Significant differences were found in attitude scores among people with different education levels(P<0.05),as well as in practice scores among people with different occupations(P<0.05).Multiple linear regression revealed that age,occupation,knowledge score and attitude score had a significant impact on practice scores(P<0.05).Patients expected to receive pharmaceutical care services from the pharmacists via face-to-face communication,network platform and telephone consultation on medication knowledge such as adverse drug reactions and response measures,drug-drug interactions,missed medication and response measures,medication adherence measures,etc.[Conclusions]AIDS patients in this hospital have a good awareness of medication safety,but their knowledge of medication use needs improvement.Some bad habits may affect their compliance,resulting in safety hazards.Therefore,there is an urgent demand for pharmaceutical care services related to rational drug use.
7.Analysis of confirmed cases of pertussis reported in Shaanxi Province
Ruize WANG ; Xiao ZHENG ; Weixuan LI ; Tiantian ZHOU ; Yake LYU ; Weijun HU
Chinese Journal of Microbiology and Immunology 2024;44(6):485-488
Objective:To investigate the current status of pertussis laboratory diagnosis and confirmed pertussis cases reporting in Shaanxi Province, and evaluate the quality of case reports.Methods:The information of confirmed pertussis cases reported in Shaanxi Province from January to July 2022 was collected through the China Disease Control and Prevention Information System. The laboratory diagnostic methods and pertussis vaccine immunization history of confirmed cases were investigated, and the descriptive epidemiological method was used for statistical description.Results:Of the 164 confirmed cases of pertussis reported from January to July 2022, two were not tested in the laboratory and 162 were tested in the laboratory. The proportions of different detection methods were 1.85% (3/162) of isolation and culture, 31.48% (51/162) of serum antibody IgG, 14.20% (23/162) of serum antibody IgM, 49.38% (80/162) of serum antibody PCR and 3.09% (5/162) of serum antibody IgM+ PCR. Among the 79 serological positive cases, 12 cases (15.19%)had no history of pertussis immunization, and 15 cases (18.99%), 11 cases (13.92%) and 41 cases (51.90%) had the time interval from vaccination to detection of <1 year, 1-3 years and >3 years, respectively. Based on the analysis of laboratory testing methods and vaccination history, 38 cases were misdiagnosed/misreported among 164 cases, with a misdiagnosis or misreported rate of 23.17%. There were 17, 12 and 9 cases of misdiagnosis/misreport in 0-2 years old group, 3-6 years old group and≥7 years old group, and the misdiagnosis or misreported rates were 27.42%(17/62), 26.67%(12/45) and 15.79%(9/57), respectively.Conclusions:The selection of pertussis laboratory testing methods in some medical institutions in Shaanxi Province is incorrect, which leads to a certain proportion of misdiagnosis or misreport, and it is necessary to further strengthen the training and standardization.
8.Diagnostic value of 18F-PSMA-1007 PET/CT in seminal vesicle invasion of prostate cancer
Anqi ZHENG ; Zhuonan WANG ; Yunxuan LI ; Dong HAN ; Cong SHEN ; Weixuan DONG ; Wang YUAN ; Xiaoyi DUAN
Chinese Journal of Nuclear Medicine and Molecular Imaging 2023;43(9):523-527
Objective:To evaluate the diagnostic value of the 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT in seminal vesicle invasion (SVI) of prostate cancer. Methods:Clinical and pathological materials of 88 patients (age: 51-84 years) who underwent radical prostatectomy (RP) between May 2019 and December 2021 in the First Affiliated Hospital of Xi′an Jiaotong University were analyzed retrospectively. All patients underwent 18F-PSMA-1007 PET/CT examination for primary staging before surgery. The diagnostic efficiency of 18F-PSMA-1007 PET/CT in SVI was obtained using postoperative pathological results as the " gold standard" and ROC curve was drawn. Furthermore, univariate and multivariate logistic regression analyses were used to screen the influencing factors for 18F-PSMA-1007 PET/CT prediction of SVI. Results:The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 18F-PSMA-1007 PET/CT in diagnosing SVI were 79.55%(70/88), 72.73%(16/22), 81.82%(54/66), 57.14%(16/28) and 90.00%(54/60), respectively. The ROC AUC was 0.77. Results of univariate logistic regression showed that total prostate specific antigen (tPSA), primary SUV max, Gleason score, International Society of Urological Pathology (ISUP) grade group were associated with 18F-PSMA-1007 PET/CT prediction of SVI. Results of multivariate logistic regression showed that Gleason score (odds ratio ( OR)=2.04, 95% CI: 1.19-3.50, P=0.009) was a predictor of SVI in prostate cancer. Conclusion:18F-PSMA-1007 PET/CT has certain diagnostic value in SVI of prostate cancer, and combining with Gleason score can improve the diagnostic efficiency.
9.Comparation of 18F-PSMA-1007 PET/CT showing prostate cancer and its infiltration area with its clinicopathology
Cong SHEN ; Yunxuan LI ; Anqi ZHENG ; Weixuan DONG ; Yang LI ; Xiaoyi DUAN
Journal of Xi'an Jiaotong University(Medical Sciences) 2022;43(2):179-185
【Objective】 To explore the value of 18F-PSMA-1007 PET/CT in evaluating the primary tumor and infiltration range of prostate cancer. 【Methods】 We retrospectively collected 18F-PSMA-1007 PET/CT whole body imaging data of the patients who came to the Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, from March 2019 to June 2021 due to suspected or diagnosed prostate cancer. No treatment was give before the examination. In addition, 51 patients underwent radical surgery after examination and obtained complete pathological results. We used a semi-automatic method to delineate the region of interest (ROI) of 40% SUVmax of prostate cancer foci, and obtained the metabolic parameters, namely, SUVmax, SUVmean, tumor metabolic volume (MTV) and total lesion metabolic (TLM). We also observed for infiltration of bilateral seminal vesicle glands and bladder. Correlation analysis was used to analyze the correlation of metabolic parameters with Gleason score and tumor grade grouping; McNemar test was used to analyze the accuracy of PSMA in evaluating the extent of prostate invasion. 【Results】 The PET/CT parameters SUVmax, SUVmean, TLM and Gleason score were not significantly correlated, but SUVmean was positively correlated with tumor grade (r=0.306, P=0.041). The pathological results showed a moderate correlation between the maximum diameter of the tumor and MTV (r=0.479, P=0.003). The sensitivity evaluated by PSMA-PET/CT to primary prostate tumor, capsule invasion, seminal vesicle gland invasion, and bladder invasion was 72.00%, 64.71%, 83.33%, and 25.00%, respectively; the specificity was 88.46%, 33.33%, 84.61%, and 95.74%, respectively; the accuracy was 80.39%, 52.94%, 86.27%, and 90.19%, respectively. 【Conclusion】 18F-PSMA-1007 PET/CT imaging has high accuracy in assessing primary tumor and the extent of invasion of prostate cancer, which indicates its value in clinical application.
10.The value of PCPT-RC high risk probability combined with Gleason score for predicting the risk of metastasis in newly diagnosed prostate cancer
Anqi ZHENG ; Yunxuan LI ; Zhuonan WANG ; Cong SHEN ; Weixuan DONG ; Wang YUAN ; Xiaoyi DUAN
Journal of Xi'an Jiaotong University(Medical Sciences) 2022;43(2):191-195
【Objective】 To investigate the value of prostate cancer prevention trial risk calculator (PCPT-RC) combined with biopsy Gleason score for predicting the risk of metastasis in newly diagnosed prostate cancer patients. 【Methods】 We retrospectively collected the data of 74 patients with newly diagnosed prostate cancer confirmed by biopsy from April 2019 to August 2021, concurrent with 18F-PSMA-1007 PET/CT whole body imaging in the same period. Based on this, a binary logistic regression model was established to obtain the high risk probability of PCPT. We calculated the receiver operating characteristic curve (ROC) was drawn and the area under the curve, Yuden index, sensitivity, specificity, positive predictive value and negative predictive value. We compared the predictive value of the prostate cancer prevention trial risk calculator and Gleason score alone or in combination in predicting the risk of prostate cancer metastasis. 【Results】 Based on the PSMA PET/CT results, 74 patients were divided into non-metastatic group (46/74) and metastatic group (28/74). PCPT high risk probability [41.14% (16%-67%)] vs. [30.89% (5%-65%)], Gleason score [8.5(6-10) score] vs. [7.7(6-9) score], tPSA [26.24(5.70-42.32) ng/mL] vs. [19.58(2.47-49.35) ng/mL], and fPSA [3.94(0.82-12.00) ng/mL] vs. [2.33(0.35-10.20) ng/mL] were significantly higher in metastatic group than in non-metastatic group. Binary Logistic regression analysis showed that Gleason score and PCPT low risk probability may be independent predictors of prostate cancer metastasis. PCPT low risk probability alone did not predict the risk of prostate cancer metastasis (P=0.172). The predictive accuracy of Gleason score and high probability of PCPT in predicting prostate cancer metastasis were 0.715 and 0.679, respectively, and the accuracy of the combined prediction was 0.809. 【Conclusion】 PCPT-RC combined with Gleason score is valuable for predicting the metastasis risk of newly diagnosed prostate cancer patients, which has certain guiding significance for clinical individualized treatment.

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