35 research outputs found
What Do We Know About Teamwork in Chinese Hospitals?:A Systematic Review
Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069
Why patients prefer high-level healthcare facilities
__Introduction__ Despite policy measure to strengthen and
promote primary care, Chinese patients increasingly
choose to access higher level hospitals. The resulting
overcrowding at higher level hospitals and underutilisation
of primary care are viewed to diminish the effects of
the continuing health system investments on population
health. We explore the factors that influence the choice of
healthcare facility level in rural and urban China and aim to
reveal the underlying choice processes.
__Methods__ We conducted eight semistructured focus
group discussions among the general population and
the chronically ill in a rural area in Chongqing and an
urban area in Shanghai. Respondents’ discussions of
(evidence-based) factors and how they influenced their
facility choices were analysed using qualitative analysis
techniques, from which we elicited choice process maps
to capture the partial order in which the factors were
considered in the choice process.
__Results__ The factors considered, after initial illness
perception, varied over four stages of health service
utilisation: initial visit, diagnosis, treatment and treatment
continuation. The factors considered per stage differed
considerably between the rural and urban respondents, but
less so between the general population and the chronically
ill. Moreover, the rural respondents considered the
township health centres as default and prefer to continue
in primary care, yet access higher levels when necessary.
Urban respondents chose higher levels by default and
seldom moved down to primary care.
__Conclusions__ Disease severity, medical staff,
transportation convenience, equipment and drug
availability played important roles when choosing
healthcare facilities in China. Strengthening primary care
correspondingly may well be effective to increase primary
care utilisation by the rural population but insufficient for
the urban population. The developed four-stage process
maps are general enough to serve as the basis for
(partially) ordering factors influencing facility level choices
in other contexts
Hybrid top down bottum up health system innovation in rural China: a qualitative analysis
Introduction
China has made considerable progress with health system reforms in recent years. Rural China, however, has lagged behind as the diversity of needs of China’s 3,000 rural counties were not always well addressed by national top-down reforms. China’s Rural Health Reform Project Health XI (HXI) piloted a hybrid process of top down and bottom up implementation of health system reforms which were tailored to rural county level needs and covered a population of more than 21 million. Different studies provide evidence that HXI counties have achieved substantial benefits given the relatively limited investment. The Effectiveness of HXI subsequently raises the question how the hybrid approach may have resulted in effective implementation of interventions. We answer this question to advance understanding of hybrid approaches in general and in the rural Chinese context in particular, where the bottom-up elements might match poorly with the traditional organisational culture and learning style.
Materials & methods
We conducted an in-depth qualitative analysis in three ‘best practice’ counties, performing document-analyses, observations, semi-structured individual and group interviews. In alignment with the research question, this study is of an explorative nature and follows a sequence of deductive and inductive steps
Results
HXI struggled initially as counties had difficulties to take initiative and autonomously select and adapt their own reforms. The initial reforms required multiple improvement iterations before achieving the planned results. The effectiveness of these bottom up reform processes has been aided by tight top down supervision and extensive domestic expert involvement. County level leadership is seen as essential to align the top down and bottom up structures and processes. Where successful, HXI has changed mind-sets and counties developed generic health improvement capabilities.
Conclusion
Tailoring innovations to fit local needs formed a severe challenge for the three ‘best practice’ counties studied. A ‘change of mindset’ to actively take initiative and assume autonomy was needed to advance. Top down supervision and extensive support of experts was required to overcome the barriers. The studied counties finally achieved sustainable improvements and developed double loop learning capabilities beyond HXI objectives. Taken together, the above findings suggest that the continuum of healthcare reform implementation approaches in which hybrid approaches reside—from bottom up to top down—has two dimensions: a content dimension and a procedural dimension. Enabled by top down procedures, counties were able to bottom up tailor the content of best practice innovations to fit local needs
CT-guided iodine-125 seed permanent implantation for recurrent head and neck cancers
<p>Abstract</p> <p>Background</p> <p>To investigate the feasibility, and safety of <sup>125</sup>I seed permanent implantation for recurrent head and neck carcinoma under CT-guidance.</p> <p>Results</p> <p>A retrospective study on 14 patients with recurrent head and neck cancers undergone <sup>125</sup>I seed implantation with different seed activities. The post-plan showed that the actuarial D90 of <sup>125</sup>I seeds ranged from 90 to 218 Gy (median, 157.5 Gy). The follow-up was 3 to 60 months (median, 13 months). The median local control was 18 months (95% CI, 6.1-29.9 months), and the 1-, 2-, 3-, and 5- year local controls were 52%, 39%, 39%, and 39%, respectively. The 1-, 2-, 3-, and 5- survival rates were 65%, 39%, 39% and 39%, respectively, with a median survival time of 20 months (95% CI, 8.7-31.3 months). Of all patients, 28.6% (4/14) died of local recurrence, 7.1% (1/14) died of metastases, one patient died of hepatocirrhosis, and 8 patients are still alive to the date of data analysis.</p> <p>Conclusion</p> <p>CT-guided <sup>125</sup>I seed implantation is feasible and safe as a salvage or palliative treatment for patients with recurrent head and neck cancers.</p
Common Molecular Etiologies Are Rare in Nonsyndromic Tibetan Chinese Patients with Hearing Impairment
Background: Thirty thousand infants are born every year with congenital hearing impairment in mainland China. Racial and regional factors are important in clinical diagnosis of genetic deafness. However, molecular etiology of hearing impairment in the Tibetan Chinese population living in the Tibetan Plateau has not been investigated. To provide appropriate genetic testing and counseling to Tibetan families, we investigated molecular etiology of nonsyndromic deafness in this population. Methods: A total of 114 unrelated deaf Tibetan children from the Tibet Autonomous Region were enrolled. Five prominent deafness-related genes, GJB2, SLC26A4, GJB6, POU3F4, and mtDNA 12S rRNA, were analyzed. Inner ear development was evaluated by temporal CT. A total of 106 Tibetan hearing normal individuals were included as genetic controls. For radiological comparison, 120 patients, mainly of Han ethnicity, with sensorineural hearing loss were analyzed by temporal CT. Results: None of the Tibetan patients carried diallelic GJB2 or SLC26A4 mutations. Two patients with a history of aminoglycoside usage carried homogeneous mtDNA 12S rRNA A1555G mutation. Two controls were homozygous for 12S rRNA A1555G. There were no mutations in GJB6 or POU3F4. A diagnosis of inner ear malformation was made in 20.18 % of the Tibetan patients and 21.67 % of the Han deaf group. Enlarged vestibular aqueduct, the most common inner ear deformity, was not found in theTibetan patients, but was seen in 18.33 % of the Han patients. Common molecular etiologies
Breast-cancer-secreted miR-122 reprograms glucose metabolism in premetastatic niche to promote metastasis
Reprogrammed glucose metabolism as a result of increased glycolysis and glucose uptake is a hallmark of cancer. Here we show that cancer cells can suppress glucose uptake by non-tumour cells in the pre-metastatic niche, by secreting vesicles that carry high levels of the miR-122 microRNA. High miR-122 levels in the circulation have been associated with metastasis in breast cancer patients and we show that cancer-cell-secreted miR-122 facilitates metastasis by increasing nutrient availability in the pre-metastatic niche. Mechanistically cancer-cell-derived miR-122 suppresses glucose uptake by niche cells in vitro and in vivo by downregulating the glycolytic enzyme pyruvate kinase (PKM). In vivo inhibition of miR-122 restores glucose uptake in distant organs, including brain and lungs, and decreases the incidence of metastasis. These results demonstrate that by modifying glucose utilization by recipient pre-metastatic niche cells, cancer-derived extracellular miR-122 is able to reprogram systemic energy metabolism to facilitate disease progression
Primary healthcare professionals’ perspective on vertical integration of health care system in China: a qualitative study
Objective This study aims to present perspectives of primary healthcare professionals (PHPs) on the impact of vertical integration on achievement of policy goals in China. To this purpose, we also explore underlying inter-professional collaboration processes based on D’Amour’s Model of Collaboration. Design A qualitative study involving individual interview and group interview was conducted between 2017 and 2018. Setting Primary healthcare institutions (PHIs) in five counties/districts of China. Participants The major participants includes twelve heads of PHIs (by twelve individual interviews) and thirty-eight PHPs (by twelve group interviews). We also interviewed other stakeholders including twenty-four health policy makers (by five group interviews) and five hospital leaders (by five individual interviews) for triangulation analysis. Results Our study indicates that PHPs perceived vertical integration has resulted in improved professional competency, better care coordination, and stronger capacity to satisfy patients’ needs. The positive impacts have varied between integration types. Contributing factors for such progress are identified at administrative, organizational and service delivery levels. Other perceived effects are a loss of autonomy, increased workload, and higher turnover of capable PHPs. Higher level hospitals played a dominant role in the inter-professional collaboration, particularly regarding shared goals, vision and leadership. These findings are different from the evidence in high-income countries. Incentive mechanisms and the balance of power with hospitals management are prominent design elements. Conclusions Our findings are particularly valuable for other countries with a fragmented health service system and low competency of PHPs as China’s experience in integrated care provides a feasible path to strengthen primary care