Objective Healthcare risk has become a popular topic in medical research field all over the world. With the increasing of healthcare safety adverse events and medical conflict cases every year, publications about this topic have been rapidly increased in China, but research on the essentials and categories of healthcare risk are still lacked. This paper aims to summarize the essentials and categories of healthcare risk research systematically through analyzing domestic studies in healthcare risk over the past decade, so as to provide decision-making evidences and policy suggenstions on healthcare risk management in China. Methods We searched the China Academic Journal Network Publishing Database of CNKI (1999-2010), in which those papers’ title containing the phrase of healthcare risk had been brought into our research, then we summerized the domestic concepts and contents in healthcare risk by essential analysis and frequency statistics. Results 255 papers were included, including 26 Class B papers (accounting for 10.20%), six Class C papers (accounting for 2.35%) and 223 Class D papers (accounting for 87.45%); but there were only 79 papers (accounting for 35.11% ) which had a clear definition of healthcare risk. From these papers, we found the essentials of healthcare risk included object, consequences, process and causes, and the research category of healthcare risk included prevention and treatment of risk, causes and effects of factors, risk sharing mechanisms, healthcare risk of special diseases, concept and characteristics, education and training, management method, risks of medical appliances, the species and object of healthcare risk, the category of healthcare risk, the research methods of healthcare risk etc. Conclusion At present, the study of healthcare risk focuses on the risk control and how to release risks from the results, besides, systematic studies are lacked, and the unified definition of healthcare risk has not been formed, Therefore, we recommend that systematic study of the healthcare risks should be strengthened, the definition of healthcare risk should be unified, and the early warning, monitoring, evaluating, and identifying methods should be positively developed, providing decision-making evidences to establish healthcare risk management system in China.
Objective To assess the rationale for including rifampicin150/isoniazid75/ethambuto/275mg fixed dose, combination oral tablets/3-FDC R150H75E275/ in the WHO Model List of Essential Medicines (WHO EML) for treatment of category II tuberculosis (TB II) and to provide evidence for the updating of national guidelines. Methods We searched Chinese Biomedical Database (CBM, 1978 to 2006), The Cochrane Library, Issue 4, 2006, the Database of Abstracts of Reviews of Effects (1994 to 2006, the Centre for Reviews and Dissemination website), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), BIOSIS Previews (1997 to 2006), websites for grey literature and the references of studies. We applied inclusion and exclusion criteria in assessing the studies we found and eligible studies were graded following an assessment of their quality. Results Thirty-six randomized controlled trials, 4 controlled clinical trials, 11 descriptive studies and 5 WHO/national guidelines were included. Rifampicin (R), isoniazid (H) and ethambutol (E) were used in the ccontinuation phase (CP) of TB II in guidelines of WHO and high tuberculosis (TB) burden countries, but the course of treatment and dosage regimens varied. R, H and E were also widely used in conditions of pulmonary tuberculosis (PTB), extrapulmonary tuberculosis (EPTB) and pulmonary diseases caused by nontuberculous mycobacteria (NTM).Conclusions It is recommended that FDC RHE be included in WHO EML for the treatment of TB II.The suggested dosage ratio of RHE is 1:1:2, which needs to be adjusted based on more solid clinical evidence. High quality clinical studies and systematic reviews on the effectiveness, safety, economics and applicability of WHO and national guidelines and their outcomes in high TB burden countries are needed to guide their updating, promote rational resource allocation and improve cost effectiveness. Alternative drugs or drug combinations with good profile of effectiveness, safety, economics, and applicability for the prevention and treatment of drug-resistant tuberculosis are also needed to be developed.
ObjectiveTo investigate the methods and significances of the breast ultrasonographic breast imaging reporting and data system (BI-RADS) category 4 lesions divided into category 4a, 4b, and 4c, and to assess the risk of malig-nancy of lesions with BI-RADS category 4 in order to improve the accuracy of diagnosis. MethodsTwo hundred and eighty-eight breast lesions with BI-RADS category 4 confirmed by histopathology were collected. The ultrasonographic characteristics of benign and malignant lesions, containing the shape, aspect ration, margin, calcification, changes of the surrounding tissue, boundary, blood flow characteristics, internal echo, rear echo of the lesions, were comparatively anal-yzed, and the lesions with BI-RADS-US category 4 were divided into 4a, 4b, 4c according to these ultrasonographic charac-teristics and analyzed by statistics. ResultsThere were 192 malignant lesions and 96 benign lesions in the 288 breast lesions. There were statistical significances in the benign and malignant lesions with the shape, aspect ratio, margin, calci-fication, change of surrounding tissue, and boundary (P < 0.05), in other words, the proportion of these ultrasonographic characteristics were higher in the malignant lesions as compared with the benign lesions. But there were no significant differences of internal echo, rear echo, and blood flow characteristics between two lesions (P > 0.05). The positive predictive value of malignant tumor with BI-RADS category 4a, 4b, and 4c were 21.74%, 58.90%, and 91.78%, respectively, and there was significant difference (χ2=106.09, P=0.000). ConclusionsThe classification of breast lesions with BI-RADS category 4 is refined, it could more accurately assess the risk of benign and malignant breast masses. At the same time, it has an important clinical significance for diagnosis and treatment of benign and malignant breast masses.