Objective  To promote the development of high-quality health standards in China and summarize the characteristics of global health standards management systems and development processes.  Methods  We conducted a systematic search of relevant databases and the websites of standardization institutions. A descriptive method was used to analyze the basic characteristics of the standard management systems and development processes.  Results  The majority of the investigated countries and organizations primarily implement voluntary standards, with the exception of Chinese and the European Committee for Standardization that enforce compulsory standards. All countries and organizations have health standards at the national, group, and enterprise levels. In China and Japan, standards authorities are subordinate to the government, while in other countries or organizations, they operate as independent civil societies. The development process for health standards generally involves five stages: "Project/Proposal → Draft → Enquiry → Review → Publication". However, the specific steps in the development of health standards vary across different countries and organizations. Furthermore, China ranks high in the number of both standards and health standards issued, but the proportion of health standards is only 2.06%.  Conclusions  There are significant differences between China and other countries in terms of the management system and development process of health standards. To promote the management and development of high-quality health standards in China, we recommend promoting the coordination mechanism for standard development, increasing efforts to publicize standards and evaluate the implementation effect, strengthening the construction of personnel for the development of health standards, optimizing the efficiency of standard development and improving the internationalization level of health standards.

National health standards involve all kinds of technical requirements formulated and numbered in accordance with the procedures and formats stipulated in the standardisation system for the implementation of national health and hygiene laws, regulations and policies, and the protection of human health. The establishment of health standards in China should align with our legal framework, including laws, regulations, departmental rules, and health and hygiene policies. During the development of these standards, a comprehensive approach is advocated, encompassing in-depth investigations, rigorous demonstrations, and extensive stakeholder engagement. However, the process of standard formulation may suffer from insufficient research evidence. The evidence-based concept emphasizes the significance of evidence. Therefore, integrating evidence-based concept into the process of developing health standards can enhance the quality and scientific basis of these standards. This article systematically elucidates the current status and development process of health standards in China, explores the necessity and feasibility of incorporating evidence-based concept into the development of these standards, analyzes the challenges and opportunities, and presents reflections and suggestions.

OBJECTIVE： To evaluate the medication of elderly inpatients receiving multiple medication， to evaluate the effects of pharmaceutical care provided by clinical pharmacists， and to provide reference for clinical drug use of elderly patients. METHODS： The elderly inpatients receiving multiple medication were selected from Beijing Friendship Hospital Affiliated to Capital Medical University during Oct. 2018 to Feb. 2019. The process of pharmaceutical care for elderly inpatients was established and developed through the CGA team of the elderly. PCNE classification system was used to analyze drug-related problems； Bayliff tool was used to evaluate the harmfulness of drug-related problems； Morisky questionnaire was used to analyze medication compliance. Drug use was followed up 3 months after discharge to evaluate the effect of clinical pharmacist’s intervention. RESULTS： A total of 71 elderly inpatients with multiple medication were included， 73.24％ of them （52 patients） suffered from 54 drug-related problems， 32 of which were related to therapeutic effects （59.26％）， 13 （24.07％） drug adverse events （possible）， 9 unnecessary drug therapy problems （16.67％）. There were 69 causes of pharmaceutical related problems， of which 58 （84.06％） were doctor’s orders. The main causes were drug selection （36.23％）， drug dosage （24.64％） and drug dosage form （20.29％）. Totally 143 interventions were conducted by clinical pharmacists， including 102 successful interventions， with success rate of 71.33％. The highest acceptance of intervention was adverse drug events reporting（100％）， followed by patient level （97.56％）， doctor level （65.12％） and drug level （52.83％）. Among 54 pharmaceutical-related problems， the most potential hazards were grade 1 hazards， involving 35 problems （64.81％）. The score of medication compliance in patients who received medication education from clinical pharmacists was （6.19±0.58）， which was significantly higher than （4.13±1.62） at the initial stage of admission （P＜0.05）. Follow-up results showed that 6 patients discontinued drugs by themselves， and 13 patients took drugs additionally by themselves. CONCLUSIONS： Drug related problems were common in elderly inpatients receiving multiple medication. Clinical pharmacists can establish a feasible pharmaceutical care process suitable for clinical needs according to the actual clinical situation. With the help of relevant evaluation tools such as relevant drug criteria， drug instructions and drug software， and at the same time， according to the physiological and pathological conditions of patients， they can cooperate with clinicians to select suitable therapeutic drugs for elderly patients to reduce the phenomenon of unreasonable medication and multiple medication， so as to improve the effectiveness and safety of drug use in the elderly.

Objective To determine the influencing factors on informed consent associated with decline or delay of primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods This study was conducted in Peking University People′s Hospital from 1 August, 2014 to 31 March, 2016, with 229 consecutive cases of acute STEMI enrolled in the study.Data were collected by reviewing medical records and STEMI treatment time records.180 patients with ischemic symptoms ≤12 hours were included in the final analysis.Patients were divided into the consent group and the refusal group according to the final decision.For patients who received primary PCI, they were further categorized into two groups based on the 30min cut-off time.Results Among the 180 STEMI patients reviewed, 139 patients agreed to primary PCI and the remaining 41 patients refused primary PCI.Multivariate logistic analysis showed that symptom relief (OR 5.532, 95% CI 1.165-26.278, P=0.031) and history of chronic kidney disease (OR 4.786, 95% CI 1.346-17.011, P=0.016) were predictors of dissent of primary PCI.Self-rated symptoms severity (OR 0.094, 95% CI 0.034-0.260, P<0.001)was predictor of consent to primary PCI.106 patients had complete time point records of informed consent in the consent group (n=139).Among these patients, the median informed consent delay was 24 min.64 patients made a decision within 30 minutes, and the other 42 patients had their decision made beyond 30 minutes.Symptom-to-door time ≥4 hours (OR 4.563,95% CI 1.682-12.385, P=0.003) was independent predictor of informed consent delay.Conclusions Patients with resolved symptoms, self-rated mild symptoms or renal insufficiency were more inclined to refuse primary PCI.For patients who eventually received primary PCI, symptom-to-door time ≥4 hours was the independent predictor of informed consent delay.

Objective To determine the normal position of the fetal conus medullaris and assess its clinical significance.Methods A total of 550 singleton pregnant women who were examined by fetal ultrasonography in the Department of Ultrasound at the Second Hospital of Fujian Medical University from June 1, 2013 to September 31, 2014 were included.Inclusion criteria were pregnancies with regular menstruation cycle and known last menstrual period, gestational age (GA) confirmed by ultrasonographic examinations, and neonate abnormality excluded by pediatrician after born.Routine obstetric ultrasound examinations were performed to measure the biparietal diameter (BPD), femur length (FL), head circumference (HC) and abdominal circumference (AC).The conus distance (CD) was determined by measuring the distance between the distal end of the conus medullaris and the caudal end of the last vertebra.The average value was calculated for each group according to GA.Fifty normal fetuses were randomly selected for quality control.For inter-observer reliability assessment, the same data were collected and analyzed by two different operators.For intra-observer reliability assessment, the data were collected and analyzed twice by the same operator with an interval of half an hour.Linear regression correlation analysis was performed to analyze the relationship between CD and GA, BPD, FL, HC and AC.Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to analyze the repeatability of the analysis.Results In 518 (94.2％) of 550 fetuses, the CD was successfully measured.Positively correlations between the conus distance and the gestational age was observed.The CD was (10.0± 3.3) mm at ＞ 14-≤ 15 weeks (n=17), (27.7±3.8) mm at ＞ 20-≤ 21 weeks of gestation (n=18), (41.5±2.4) mm at ＞ 26-≤ 27 weeks (n=8), (54.7±3.0) mm at ＞ 32-≤ 33 weeks (n=17), and (71.9±2.7) mm at ＞ 41-≤ 42 weeks (n=6).Linear regression correlations between CD (mm) and FL, AC, HC, BPD and GA were:CD=1.04× FL (mm)-8.71, CD=0.23 × AC (mm)-10.11, CD=0.28× HC (mm)-18.10, CD=0.90× BPD (mm)-17.65, CD=2.34× GA (weeks)-20.94 (r=0.990, 0.985, 0.978, 0.974 and 0.973, respectively, all P ＜ 0.01).The measurement of the conus distance exhibited good reproducibility between different operators (ICC=0.984, 95％CI: 0.972-0.991) and for the same operator (ICC=0.992, 95％CI: 0.985-0.995) with the 95％ limits of agreement of-1.8 to 3.5 mm and-4.3 to 2.1 mm.Bland-Altman analysis showed that most of the measured values were within 95％ confidence interval suggesting good consistency.Conclusions The distance, between the end of the conus medullaris and the end of the last vertebral body under ultrasound scan, is positively correlated with FL and other ultrasonographic indicators, which implies that it could be used as a new index for position of fetal conus medullaris.

Objective To explore nurse′s shortcoming repair scheme ( NSRS ) impacting on nursing quality in Operating Room ( OR) . Methods A total of 62 OR nurses had been chosen as sampling received NSRS after utilizing nurse′s shortcoming scale to acquire shortcomings. Results Nurses had the more younger, lower occupational title and educational background, the easier acquired shortcomings. After application of NSRS, the total comprehensive abilities of nurses improved apparently, of which the comprehensive ability of grade N0, N1, N2, N3 and N4 nurses were (70. 36 ± 5. 38), (74. 86 ± 7. 25), (76. 38 ± 6. 86), (82. 35 ± 4. 72), (86. 97 ± 2. 35) scores before NSRS implementation improved to (79. 58 ± 3. 61), (83. 69 ± 3. 45), (85.31 ±3.11), (90.56 ±2.45), (96.48 ±2.33) after NSRS implementation (t=9.846, 9.012, 9.327, 8. 742, 11. 356;P <0. 01). Before NSRS implementation, the rates were 14. 52%, 19. 35%, 16. 13%, 20. 97%, 17. 74%, 9. 68 % and 27. 42% for taking wrong patents, arranging wrong operative position, incomplete operative equipment preparation, counting mistake, improper use of equipment, medicine error, specimen improper preservation; after NSRS used, there were just one cases for arranging wrong operative position and count error, and the other 6 parts had no nursing error. Conclusions Through repairing nurse′s shortcoming, the incidence of nursing error reduces and the overall OR nurses′comprehensive abilities improve. It also can reduce the surgical care in the process of the accident, and improve the nursing quality of OR.

Objective To investigate the application of integrated medical care model in transurethral 2μm laser enucleation of the prostate patients .Methods Integrated medical care model was applied from June 2013 in transurethral 2 μm laser enucleation of the prostate patients .Health care work ability , incidence of complications , satisfaction of the health care work were compared before and after the implementation of integrated medical care model .Results Before the implementation of integrated care clinic capacity , the scores of health communication skills, teamwork skills, ability to work nursing, nurse-patient relationship were (16.5 ± 2.2),(13.2 ±3.6),(10.5 ±2.1),(16.5 ±3.6),(15.4 ±2.8), respectively; after implementation of integration the scores were (17.0 ±2.1),(17.8 ±4.2),(16.9 ±3.7), (17.0 ±3.4), (18.4 ±3.3), and medical care communication skills , teamwork, nurse-patient relationship scores were higher than that before the application of health care integration , the differences were statistically significant (t=6.592 9,3.718 9,6.727 5, 3.100 0, respectively;P<0.05).The total incidence of complications of observation group was lower than the control group, the difference was statistically significant (8.1% vs 24.2%,χ2 =5.961 5,P<0.05).Health care job satisfaction score of observation group was (87.1 ±6.8), significantly higher than the control group (t=10.48,P<0.05).Conclusions Application of integrated medical care model in transurethral 2μm laser enucleation of the prostate patients can help improve coordination and work capacity , reduce patient morbidity and improve patient satisfaction with health care work , which is worthy of clinical application .

Objective To study the correlation between genetic polymorphisms of interleukin (IL)-1A/1B and susceptibility to tuberculosis (TB).Methods Genetic polymorphisms of IL-1A and IL1 B in 1032 TB patients and 1008 non-TB patients were analyzed using PCR-MassARRAY method.The correlation between genetic polymorphisms of IL-1A/1B and susceptibility to TB was statistically analyzed.Results Two tag SNPs of IL-1A and three tag SNPs of IL-1B were screened for the study.There were differences in the allele frequencies of rs2853550 and rs3783526 between TB group and non-TB group (P=0.047and P =0.034,respectively).IL-1 B SNP1 rs2853550 (P =0.025,OR =1.302,95 ％ CI =1.034-1.640,TC vs.CC) was found to be highly associated with TB,while the other SNPs showed no significant correlations with TB.Furthermore,IL-1B SNP1 rs2853550 [P=0.019,OR=1.308,95％ CI=1.045-1.638 for (TC+TT) vs.CC] in the dominant model conferred significant risk for TB,but IL-1A SNP2 rs3783526 [P=0.000,OR=0.764,95％ CI =0.591-0.988 for GG vs.(AA+GA)] in the recessive model showed protective effects against TB.The haplotype ‘TG’ in the IL-1B block showed a higher risk for TB compared with the common ‘ CA’ haplotype (P=0.032,OR=1.265,95％ CI=1.020-1.567).The diplotypes containing ‘ GA’ haplotype in IL-1A block and ‘ TG’ haplotype in IL-1B block were major risk factors for TB (for onecopy,adjusted P=0.014,OR=1.403 and 95％ CI=1.072-1.836; adjusted P=0.013,OR=1.339 and 95％ CI=1.063-1.688,respectively),but the diplotype with ‘CG’ in IL-1B block played a protective effect against TB (for two-copy,P=0.006,OR=0.664 and95％ CI=0.494-0.891).Conclusion The genetic polymorphisms of IL-1B rs2853550 might be closely associated with TB,but the GG genotype of IL1 A SNP rs3783526 might have the characteristic of anti-TB.

Objective To study the relationship between the genetic polymorphisms of carboxylesterase 1 gene (CESI) and the susceptibility to antituberculosis drug-induced hepatotoxicity (ATBDIH).Methods Genetic polymorphisms of CES1 in 473 tuberculosis patients with or without hepatotoxicity (200∶ 273) after antituberculosis chemotherapy were analyzed by PCR-MassArray.Results In4 tags of CES1 single nucleotide polymorphism (SNP),the frequency of the rs1968753 allele had statistical difference between the hepatotoxicity group and the no-hepatotoxicity group ( P =0.0236 ).The characteristics of anti-hepatotoxicity had been shown relationship with rs8192950 ( P =0.044,OR =0.649,95％ CI =0.426-0.989,AC/AA ) and rs1968753 ( P =0.048,OR =0.556,95％ CI =0.311-0.995,GG/AA).The diplotypes with ‘ CGC' haplotype exhibited significant protection against hepatotoxicity at one copy (P=0.048,OR=0.654,95％CI=0.430-0.996).Conclusions The genetic polymorphisms of CESI might have significant association with ATBDIH.SNP rs8192950 AC genotype and rs1968753 GG genotype might be the candidates for risk prediction of ATBDIH.

To observe the cerebral activating effects of needling at Waiguan (SJ5) versus SJ5 plus Yanglingquan (GB34) points in young healthy volunteers based on the hypothesis of "needling effect of combined acupuncture points relates to the brain activation".