Objective To investigate the effectiveness of homemade antibiotic bone cement rod in the treatment of tibial screw canal osteomyelitis by Masquelet technique. Methods A clinical data of 52 patients with tibial screw canal osteomyelitis met the criteria between October 2019 and September 2020 was retrospectively analyzed. There were 28 males and 24 females, with an average age of 38.6 years (mean, 23-62 years). The tibial fractures were treated with internal fixation in 38 cases and external fixation in 14 cases. The duration of osteomyelitis was 6 months to 20 years with a median of 2.3 years. The bacterial culture of wound secretions showed 47 positive cases, of which 36 cases were infected with single bacteria and 11 cases were infected with mixed bacteria. After thorough debridement and removal of internal and external fixation devices, the locking plate was used to fixed the bone defect. The tibial screw canal was filled with the antibiotic bone cement rod. The sensitive antibiotics were given after operation and the 2nd stage treatment was performed after infection control. The antibiotic cement rod was removed and the bone grafting in the induced membrane was performed. After operation, the clinical manifestations, wound, inflammatory indexes, and X-ray films were monitored dynamically, and the postoperative bone infection control and bone graft healing were evaluated. Results Both patients successfully completed the two stages of treatments. All patients were followed up after the 2nd stage treatment. The follow-up time was 11 to 25 months (mean, 18.3 months). One patient had poor wound healing and the wound healed after enhanced dressing change. X-ray film showed that the bone grafting in the bone defect healed and the healing time was 3-6 months, with an average of 4.5 months. The patient had no recurrence of infection during the follow-up period. Conclusion For the tibial screw canal osteomyelitis, the homemade antibiotic bone cement rod can reduce the recurrence rate of infection and obtain a good effectiveness, and has the advantages of simple operation and less postoperative complications.
Objective To systematically review the issues and countermeasures in supervising medical insurance funds under the DRG/DIP payment model. Methods The CNKI, WanFang Data, CBM, VIP, PubMed, Web of Science, and Embase databases were electronically searched to collect studies related to objectives from inception to March 15, 2024. Two reviewers independently screened the literature, extracted data, and assessed the quality of the included studies using the Critical Appraisal Skills Programme (CASP). Excel 2019 was used for data extraction and organization, and a thematic synthesis approach was employed for analysis. Results Nineteen qualitative studies were included. Nine studies identified key issues in fund supervision under the DRG/DIP model: inadequate regulatory mechanisms, weak regulatory capacity, low informatization, and traditional regulatory concepts. Fourteen studies proposed optimization strategies, including establishing a regulatory system, customizing regulatory indicators, creating a performance evaluation mechanism, developing talent, promoting multi-party regulation, enhancing intelligent supervision systems, and improving stakeholder collaboration and communication. Conclusion The DRG/DIP payment model faces challenges in medical insurance fund supervision, including weak mechanisms and capacity. Improving regulatory efficiency and ensuring medical service quality requires strengthening the regulatory system, customizing indicator systems, and enhancing talent development.
ObjectiveTo systematically review the research issues related to evidence quality grading methods for public health decision making. MethodsPubMed, Web of Science, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect studies related to the application of evidence quality grading methods for public health decision making from inception to December 2022. The questions were constructed according to the SPIDER model. The quality of the included literature was evaluated by using the CASP checklist, and a three-level interpretation analysis of the questions on the application of quality rating methods for public health decision making was conducted using the thematic synthesis method to establish a pool of question entries. ResultsA total of 14 papers were included, covering seven countries. GRADE was the commonly used method for grading the quality of evidence. CASP evaluation results showed eight high quality studies, four medium quality studies and two low quality studies. The thematic synthesis method summarized 13 question entries in 7 categories. ConclusionThe existing methodology for grading the quality of evidence for public health decision making suffers from the diversity of evidence sources and the underestimation of the level of evidence from complex intervention studies.
Objective To assess the methodological quality of systematic reviews/ meta-analysis of burden of illness, analyses the factors affecting it, so as to provide a reference basis for improving the methodological quality of related studies. Methods Systematic reviews/ meta-analysis of burden of illness were identified in PubMed, searching from its inception to 12 October 2024. Systematic reviews/ meta-analysis of burden of illness was included, the methodological quality of the included literature was evaluated using AMSTAR-2, and data were extracted using Excel 2021. Results A total of 308 systematic reviews/ meta-analysis were included, with a fluctuating upward trend in the number of publications from 2006 to 2024; of these, a total of 12 were rated as low quality. According to the AMSTAR-2 entries, the largest number of documents fully conformed to entry 16 (82.14%), followed by entry 5 (81.49%), and entry 8 (72.73%); one document conformed to entry 10 (0.32%), and relatively few conformed to entry 12 (68.83%), entry 13 (85.39%), and entry 15 (67.53%). ConclusionThe methodological quality of systematic reviews/ meta-analysis of burden of illness needs to be improved, and the main problems include the lack of pre-study protocols, the absence of a list of excluded literature, and the less than adequate explanation of heterogeneity and risk of bias, etc. There is still a need to further improve the methodological quality of the systematic reviews and to promote the long-term development of evidence based medicine.
ObjectiveTo construct rapid health technology assessment (RHTA) reporting norms, with a view to providing methodological references for RHTA research and reporting. MethodsBased on the preliminary pool of entries constructed by the literature research results, and taking into account the characteristics of RHTA, a Delphi expert correspondence questionnaire was designed, and 25 experts in the field of HTA were selected to conduct multiple rounds of expert correspondence. By calculating the expert authority coefficient and opinion coordination coefficient, combined with the average value of the entry score, coefficient of variation and full score ratio, the entries were selected to form the list of RHTA report specifications. ResultsThe positive coefficient of experts in both rounds of investigation was 100%, the expert authority coefficient in the first round was 0.858, and the expert authority coefficient in the second round was 0.838. The Kendall coordination coefficient in the first round was 0.169, and in the second round it was 0.081. According to the correspondence of 2 rounds of investigation, the final formation included 8 aspects, 26 first-level entries and 18 second-level entries in the list of RHTA report specifications. ConclusionThis study constructed the RHTA report specification, which is both scientific and operable, providing a reference for RHTA report writing.