Assessing the Brazilian clinical practice in patients with acute coronary syndrome, in public and private hospitals to identify gaps in the incorporation of clinical interventions with proven benefit. To develop a registry of patients diagnosed with acute coronary syndrome to assess demographics, morbidity, mortality, and standard practice in the care of this condition. Besides, to assess the prescription of evidence-based interventions such as aspirin, statins, beta blockers and reperfusion, among others. Registry-type prospective observational study intended to document hospital clinical practices of acute coronary syndrome in public and private hospitals in Brazil. In addition, longitudinal follow-up will be held until discharge and measurement of mortality and occurrence of serious events at 30 days, 6 and 12 months. The findings will be presented one year after the start of collection (September 2011), and consolidated after a meeting with the population to discuss the objectives sought. The analysis of this multicenter registry will design a horizontal perspective for the treatment of patients suffering from cardiovascular disease in Brazil.
While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.
Smart home devices have great potential to improve the quality of life and independence of older people, positively impacting their health, safety, and comfort. However, Chinese research in this field is still in its early stages. Therefore, more comprehensive and in-depth studies are needed to comprehend the various aspects influencing the acceptance and use of smart homes by older users. This study adopted the Technology Acceptance Model (TAM) and included perceived usefulness, perceived ease of use, usage intention, intergenerational technology support, perceived value, and perceived risk as extension variables to delve deeper into the behavioral intentions of older users in smart home services. The study used a convenience sampling method to randomly distribute 236 questionnaires among older adults over the age of 60 in the school's community and neighboring urban communities who have experience in smart home use and who can complete human-computer interactions either independently or with the help of others, mainly focusing on the four sections: user characteristics, family situation, experience of use, and usage intention. The study used structural equation modeling (SEM) and factor analysis to analyze the completion of questionnaires. Finally, we conducted a validation analysis of the rationality and scientificity of the model and derived the six dimensions of the model of the influencing factors on the use of smart home products by the elderly and the weight sizes of their corresponding 13 influencing factors. The results show that perceived usefulness and perceived ease of use have a positive effect on users' intention to use smart homes. Perceived ease of use has a positive effect on the perceived usefulness of smart homes. In addition, intergenerational technology support, perceived value, and perceived risk impact users' perceived usefulness and perceived ease of use of the smart home. This research aims to describe the factors influencing older users' willingness to use smart homes. The findings are not only significant for the elderly in China but also of broad value to other regions and countries facing similar demographic challenges. The development of smart homes not only involves the elderly but is also closely related to all segments of society. The government should increase policy support and guide more social forces to participate in the development of the smart home industry. Service providers and designers should fully understand the demand situation and user experience of target users to develop easy-to-use smart home solutions. At the same time, smart homes, as intelligent products for the elderly, need to focus not only on the basic needs of the elderly such as material life and home safety, but also on the spiritual needs of elderly users. Children or caregivers should always pay attention to the psychological state of the elderly and actively guide them to use smart homes to help them realize their self-worth. We look forward to more research focusing on this area in the future and further exploring the specific issues and solutions involved.
We investigated the relationship between strong-ties versus weak-ties rationality and public stigma (PS) during the COVID-19 pandemic. We also explored the cultural group differences (Malaysians vs. Australians) in this relationship. An online survey was conducted in 2021 with a final sample of 830 eligible Malaysians and 394 eligible Australians. Participants completed the multidimensional strong-ties weak-ties rationality Scale (STWTRS) and an adapted public stigma (PS) scale towards COVID-19 patients. Through multiple regression analysis, we found that the strong-ties rationality, ST-Authoritarian rationality, was positively associated with PS-Blame in both countries. However, the variable Country moderated the relationship between ST-Communal and PS-Rejection, with a negative association found in Malaysia and a positive association in Australia. The findings confirmed the strong-ties weak-ties rationality framework, where ST rationality, especially ST-Authoritarian, could explain the cognitive mechanism behind negative attitudes towards those who pose threat towards the in-group survival. However, ST-Communal could buffer the rejection towards the COVID-19 patients in Malaysia due to its emphasis on social harmony. This study can inform future interventions aimed at mitigating stigma and promoting a more inclusive and supportive society in times of crisis.
With the in-depth understanding of osteonecrosis of femoral head (ONFH), and more and more patients seeking medical treatment in the early stage of the disease, surgical treatment of femoral head necrosis alone is no longer sufficient for the current treatment of patients' demand, how to rationally and effectively apply drugs to strengthen the early prevention and treatment of femoral head necrosis and delay the progression of disease is becoming more and more important. This article combines the latest expert consensus and evidence-based medical evidence on the principles of ONFH diagnosis and treatment in Chinese and Western medicine at home and abroad, combined with domestic actual clinical application experience, and is organized by experts from Association Related to Circulation Osseous Chinese Microcirculation Society (CSM-ARCO) to write this consensus, focusing on the types of ONFH drugs, the characteristics, safety, rationality and basic principles of drug use provide reference opinions for the safe, reasonable, standardized and effective drug use of medical institutions at all levels. This consensus is only an expert guideline based on literature and clinical experience, not as a requirement for mandatory implementation, let alone as a legal basis. The clinical practice could be tailored to the actual local conditions to develop appropriate prevention and treatment measures for patients.
In this postmodern society, people tend to abandon conventional medicine for alternative medical systems, such as acupuncture. What are the reasons for this defiance regarding modern rationality and individualist success? Who turns to acupuncture? This study (n=89) examined whether world views opposed to the predominance of rationality (i.e., mistrust of science, spirituality, paranormal beliefs) and individualist success or consumerism (i.e., power, achievement, and materialism), typically associated with the postmodern era, might explain this attraction toward acupuncture. Participants were recruited through Internet forums interested in complementary and alternative medicine and completed the questionnaire voluntarily. Attraction to acupuncture related negatively with materialism and achievement as well as positively with spirituality, paranormal beliefs, and mistrust in science. Spirituality, paranormal beliefs, and low achievement were the main predictors of attraction to acupuncture and explained 44% of the variance. The mistrust in science mediated the relationship between spiritual and paranormal beliefs and the attraction toward acupuncture. Low achievement explained the link between low materialism and positive attitudes toward acupuncture. The general mistrust of our rational and individualist modern society is indeed an important predictor of attraction toward acupuncture, in addition to demographic variables.
The nursing care experiences of older people in the United Kingdom, has been much reported in the national and international press. Reasons for that poor quality of care in hospitals often focus on the 'culture' of organisations, as well as focusing on individual failings. However, discussions about culture change are partial explanations without a deeper analysis of how cultures and leadership operates in socio-political contexts which characterise nurses' 'habitus' and 'lifeworlds'. Therefore the solutions may not address wider determinants of care such as risk governance, managerialism, instrumental rationality and of course staffing and skill mix. Instead, organisations may be exhorted to change their cultures, without addressing these wider determinants and thus poor care practices may continue to occur. If targets are abolished, this may still leave a layer of managerialist thinking. This impacts on education because students, who are 'working and learning', experience occupational socialisation through immersion in the lifeworlds of their clinical colleagues. What is required is much less manageralism in the care of older people. Instead, there is a need for clinical leadership, based on critical reflective understanding of the occupational socialisation of nurses operating in a context of risk and rationality and organisational objectives; collegiate political and moral action by health professionals and society on behalf of the older person, and support for front line staff who require more autonomy and control over care practices.
Against the backdrop of global population aging and adjustments in health policies, the fair and efficient allocation of urban health resources for older adults has become a key issue in urban planning and resource management. From a supply-demand matching perspective, this study proposes a classification method for urban health resources for older adults, categorizing them into three types: uniform distribution, hierarchical, and independent. A classification and evaluation system is constructed based on four core dimensions: accessibility, service load, selectivity, and suitability. This study highlights the importance of spatial heterogeneity analysis and multi-source data integration. By combining GIS spatial analysis, network modeling, and the Analytic Hierarchy Process, a Spatial Demand-Supply Matching Index (SDMI) calculation model is developed. Through weighted evaluation, the model quantifies the degree of matching between supply and demand, assessing the balance of elderly health resource distribution across different regions. Using Chongqing, a typical high-density megacity, as a case study, the proposed evaluation framework effectively identifies areas with uneven resource distribution, excessive burden, or limited accessibility, providing data-driven optimization strategies. The results indicate that this method can systematically assess resource accessibility, supply-demand matching, and the rationality of spatial distribution across urban areas, thereby supporting improvements in equity and accessibility of healthcare resources allocation. This approach can be adapted to other high-density cities with context-specific calibration of indicators and weights, contributing to more efficient health resource provision in aging societies and the sustainable development of urban health service systems.
In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. We collected 13,678 participants through online representative sampling across six countries-Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom-during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43%) and the United Kingdom (759/1484, 51.15%); followed by Taiwan (2841/5989, 47.44%), Australia (963/2086, 46.16%), and Spain (693/1491, 46.48%); and was the lowest in Japan (241/1081, 22.94%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95% CI 1.13-1.22), personal concern (OR 1.07, 95% CI 1.00-1.16), perceived virus severity (OR 1.07, 95% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95% CI 2.36-2.66), liking immunity passports (OR 2.77, 95% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95% CI 0.82-0.98), immunity passport concern (OR 0.61, 95% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world.
To assess the current status and determinants of medication safety among rural older residents in Luzhou City, with the aim of informing targeted strategies to promote safe and rational medication use. A cross-sectional study was conducted involving 100 older adults (≥60 years) and 60 primary care physicians from rural Luzhou. Data collection included structured questionnaires on medication use, adherence, and safety knowledge, as well as a review of 100 outpatient electronic medical records (EMRs) for chronic disease management. Prescription rationality was evaluated using the Medication Appropriateness Index (MAI), and potentially inappropriate medications (PIMs) were identified according to the 2023 American Geriatrics Society Beers Criteria. Descriptive statistics and chi-square tests were applied to examine associations between sociodemographic factors and unsafe medication practices. Polypharmacy (≥3 concurrent medications) was reported by 72% of older participants, with 81% taking antihypertensive or cardiovascular drugs. Unsafe practices were common: 47% altered medication timing or missed doses, and 37% self-adjusted dosages. Knowledge gaps were evident, as only 43% consulted pharmacists about dosing or precautions, and just 23% would discontinue a drug and seek help if experiencing an adverse reaction. Lower education and household income were significantly associated with unsafe behaviors (p = 0.014). Among EMRs reviewed, 2% of prescriptions were rational, and 12% contained PIMs, most frequently long-acting benzodiazepines and NSAIDs. Rural older people in Luzhou face significant medication safety challenges, driven by high rates of polypharmacy, unsafe self-management behaviors, and socioeconomic disparities. Interventions should combine patient education, improved physician-patient communication, and systematic prescription review to reduce inappropriate medication use and related adverse outcomes.
Farmers are rational. They do what makes sense to them in the particular circumstances of their farm, family and business. The challenge for those who want to influence farmers' behaviour - policy makers, veterinarians, public health professionals - is to understand their rationality, to gain some insight into how they see the world and the various options it offers to them. This study explores some of the reasons that emerge from recent research on why their decisions are not always the ones that other people expect or want them to take. These include differences in values, motivations, social influences and behavioural types. Also relevant is how farmers view the sources from which advice and information are seen to come: some advice is rejected simply because a farmer does not see the person or organization as a trustworthy source. It is now widely accepted that farmers' motivations for continuing what they are doing, and for changing what they are doing, are not simply economic or financial. Their decisions cannot be predicted on the basis of simplistic notions of 'economic rationality'. While costs and returns are clearly important in weighing up choices (and farm management economics has given us several useful tools and methodologies for analysing these), farmers operate within a social context that both constrains and facilitates their behavioural choices. They have complex sets of core values, just like anyone else, which will make some choices more attractive than others that are potentially more rewarding financially. It is therefore appropriate to look to the wider family of social sciences beyond economics, including sociology, psychology and social psychology, to help us understand more fully the factors that inform and influence farm-level decisions. And this improved understanding should make us better at designing policy and advisory interventions that will benefit farmers and society.
1. Construct a risk prediction model to predict the factors of high intraoperative bleeding in patients undergoing posterior lumbar decompression and fusion internal fixation surgery during outpatient visits. 2. Implement pre-hospital blood management for surgery patients, to improve clinical outcomes. We collected patients who underwent two-segment and three-segment posterior lumbar decompression and fusion internal fixation surgery in our hospital from 2016 to 2021. A total of 24 preoperative indicators were analyzed, covering medical history, demographic characteristics, segment, operator and laboratory test results. We used a logistic regression model to optimize the model's feature selection. The predictive model was constructed using the multivariable logistic regression method with all included methods, and a nomogram was created to display the model. Activated partial thromboplastin time, surgeon volume, American Society of Anesthesiologists classification, body mass index, and the number of fusion and fixation lumbar segments were used to construct the predictive model. The predictive model's discrimination, calibration, clinical applicability, and rationality were evaluated. The predictive model's area under the receiver operating characteristic curve is 0.723, with a 95% confidence interval of (0.685-0.760). The training set's decision curve analysis demonstrates that applying this diagnostic curve will increase the net benefit when the threshold probability is between 5% and 40%. This study developed a novel nomogram with relatively good accuracy to assist clinical doctors in assessing the high intraoperative bleeding risk in patients undergoing posterior lumbar decompression and fusion internal fixation surgery during outpatient visits. By evaluating individual risk, surgeons can develop an individualized treatment plan to reduce the risk of intraoperative bleeding for each patient.
The same dataset can be analysed in different justifiable ways to answer the same research question, potentially challenging the robustness of empirical science1-3. In this crowd initiative, we investigated the degree to which research findings in the social and behavioural sciences are contingent on analysts' choices. We examined a stratified random sample of 100 studies published between 2009 and 2018, in which, for one claim per study, at least five reanalysts independently reanalysed the original data. The statistical appropriateness of the reanalyses was assessed in peer evaluations, and the robustness indicators were inspected along a range of research characteristics and study designs. We found that 34% of the independent reanalyses yielded the same result (within a tolerance region of ±0.05 Cohen's d) as the original report; with a four times broader tolerance region, this indicator increased to 57%. Of the reanalyses conducted, 74% reached the same conclusion as the original investigation, 24% yielded no effects or inconclusive results and 2% reported the opposite effect. This exploratory study indicates that the common single-path analyses in social and behavioural research should not be simply assumed to be robust to alternative analyses4. Therefore, we recommend the development and use of practices to explore and communicate this neglected source of uncertainty.
This paper examines a remarkable dispute between Dutch insurers, hospitals, doctors, and patients about a set of quality indicators. In 2013, private insurers planned to drastically reform Dutch emergency care using quality indicators they had formulated drawing from clinical guidelines, RCTs, and systematic reviews. Insurers' plans caused much debate in the field of emergency care. As quality indicators have come to play a more central role in health care governance, the questions what constitutes good evidence for them, how they ought to be used, and who controls them have become politically and morally charged. This paper is a case study of how a Dutch public knowledge institution, the National Health Care Institute, intervened in this dispute and how they addressed these questions. We conducted ethnographic research into the knowledge work of the National Health Care Institute. Research entailed document analysis, participant observation, in-depth conversations, and formal interviews with 5 key-informants. The National Health Care Institute problematized not only the evidence supporting insurers' indicators, but also-and especially-the scope, purpose, and use of the indicators. Our analysis shows the institute's struggle to reconcile the technical rationality of quality indicators with their social and political implications in practice. The institute deconstructed quality indicators as national standards and, instead, promoted the use of indicators in dialogue with stakeholders and their local and contextual knowledge. Even if quality indicators are based on scientific evidence, they are not axiomatically good or useful. Both proponents and critics of Evidence-based Medicine always feared uncritical use of evidence by third parties. For non-medical parties who have no access to primary care processes, the type of standardized knowledge professed by Evidence-based Medicine provides the easiest way to gain insights into "what works" in clinical practice. This case study reminds us that using standardized knowledge for the management of health care quality requires the involvement of stakeholders for the development and implementation of indicators, and for the interpretation of their results.
Aksoy et al. (2026) propose three standards for sociology, the integration of theory and empirics, open science, and a careful relation between scholarship and political action. In this comment, we endorse these standards and argue that two developments, the uneven geography of sociological knowledge and the disciplinary reach of artificial intelligence, call for a wider frame. We propose reciprocal collaboration with researchers in the Global South as a single move that absorbs the disruption from AI, corrects an empirical deficit, and narrows the methodological gap, while extending rather than diluting the standards the statement defends.
Optimizing the trade-off between economic growth and public health is a major goal of public administration, especially during public health events. Although containment measures are widely used to combat the Covid-19 outbreak, it is still debated how the measures affect the economy. Using a simplified susceptible-infected-recovered (SIR) model, this study investigates the dynamic impact of lockdown policy on social costs during the epidemic and the underlying mechanism, revealing that the lockdown policy has both a "shutdown effect" and an "anti-epidemic effect", and should be implemented and lifted in a timely manner. Based on a micro-level dataset of 57,547 private enterprises in China in 2020, this study provided empirical evidence for the presence of negative "shutdown effect" and positive "anti-epidemic effect" of lockdown on reopening, both of which are in part mediated by labor input, factor mobility, and market demand recovery. Furthermore, the shutdown effect is weaker in regions with sufficient testing and quarantine resources, government capacity and preference for targeted response, whereas the anti-epidemic effect is stronger in densely populated areas with relatively low public compliance. Additionally, digital measures can aid in the containment of epidemics. The findings not only contribute to a better understanding of the rationality and effectiveness of the lockdown policy, but also provides practical evidence and implications for the government to improve the synergistic efficiency of epidemic control tools and strengthen the resilience of local economic growth.
The principle of justification is intended to ensure the net benefit of a proposed activity that would alter radiation exposure. While the concept is simple and easy to understand, its application, including the basis for judgments and the process for reaching a decision, is not straightforward. It has been demonstrated in the last decades that the decision-making process in radiological protection and safety requires not only scientific and technical rationality but also consideration of stakeholder views to appropriately reflect societal and ethical values. In view of these emerging challenges, the International Commission on Radiological Protection created Task Group 124 for the purpose of revisiting and modernizing the principle of justification. The Task Group collected various views and opinions of radiation protection experts through an online workshop and an international conference. They were examined to identify areas that need further clarification and to extract ideas that were not given sufficient consideration in the past. The Task Group is working to compile a report that identifies essential elements and key perspectives in the decision-making process for justification. It aims to clarify what "do more good than harm" means in society today and on what basis the judgment should be made.
Polygonatum kingianum Coll. & Hemsl (PK), a prominent medicine and food homology plant, has been consumed as a decoction from boiling water for thousands of years. 'Nine Steaming Nine Sun-drying' processing has been considered an effective method for enriching tonic properties, but studies investigating such impacts on PK and underlying mechanisms are extremely rare. We first demonstrated substantial improvements in the anti-oxidative, anti-inflammatory and anti-hyperglycemia effects of the Nine Steaming Nine Sun-drying processed PK water extracts compared with crude PK in cell models (i.e., HepG2 and Raw 264.7 cells). We then integrated foodomics and network pharmacology analysis to uncover the key compounds responsible for the improved benefits. A total of 551 metabolites of PK extracts were identified, including polyphenols, flavonoids, alkaloids, and organic acids. During processing, 204 metabolites were enhanced, and 32 metabolites were recognized as key constituents of processed PK responsible for the improved health-promoting activities, which may affect PI3K-Akt-, MAPK-, and HIF-1 pathways. We further confirmed the high affinity between identified key constituents of processed PK and their predicted acting targets using molecular docking. Our results provide novel insights into bioactive compounds of processed PK, elaborating the rationality of processing from the perspective of tonic effects. Consuming processed PK could be an efficacious strategy to combat the high prevalence of metabolic diseases that currently affect millions of people worldwide. © 2023 Society of Chemical Industry.
This article analyzes the presence and induction of Permanent Health Education (PHE) in Health Economics (HE) within the official documents of the Department of Health Economics and Development (DESID) of Brazil's Ministry of Health (MoH). This is an exploratory and descriptive qualitative study, grounded in the document analysis of 126 records categorized according to the elements proposed by Williams and content analysis based on Bardin's method (2016). The findings revealed a lack of programmatic, budgetary, and strategic guidelines specifically aimed at PHE in Health Economics, as well as a restricted provision of specialized courses and limited integration with public health management policies. Comparative analysis with international experiences, including the United Kingdom, Belgium, and South Africa, demonstrates that the institutionalization of HE training fosters greater efficiency, equity, sustainability, and rationality in the use of public resources. The findings suggest that continuous technical qualification in this field constitutes an essential component for strengthening Brazil's National Health System (SUS). In this context, there is a clear need for the formulation of government policies that stimulate, incentivize, and expand PHE in Health Economics, leveraging the potential of technological platforms such as AVASUS and the Brazil Telehealth Program, both of which possess significant reach, adherence, and engagement across the national territory.
To investigate the effectiveness and safety of clinical pharmacists-directed vancomycin dosing and therapeutic drug monitoring (TDM), and to promote the individualized medication of vancomycin. Information of hospitalized patients treated by vancomycin admitted to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2011 to October 2017 was collected retrospectively during study period, the patients were divided into pharmacists intervention and non-pharmacists intervention groups according to pharmacist-directed vancomycin dosing guideline or not. The individualized dosing regimen of vancomycin for the patients in pharmacists intervention group was guided by clinical pharmacists, this guideline was that pharmacists offered the TDM guidance, made the individualized dosage regimen of vancomycin, etc., which based on the patients' pathophysiology, condition, and the adjustments of increased dose or 24-hour continuous infusion vancomycin were made for patients if the steady-state trough concentrations fell below the target level. Vancomycin dosage was made for patients in the non-pharmacists intervention group by physicians only based on vancomycin instructions or clinical experience. The vancomycin dosing, TDM, microorganism culture, renal function, 30-day mortality rate, and length of hospital stay were recorded. The appropriateness of TDM for vancomycin was defined as a blood collection within 1 hour of the next scheduled dose after steady state achieved. The rationality of the initial dosing regimen was determined based on the vancomycin application guidelines issued by Infectious Diseases Society of America (IDSA) in 2009. A total of 258 patients were enrolled, and there were 158 patients in the non-pharmacists intervention group and 100 in pharmacists intervention group. The appropriateness of TDM for vancomycin in pharmacists intervention group was significantly improved as compared with that in non-pharmacists intervention group [87.0% (87/100) vs. 69.6% (110/158), P < 0.01], the percentage of first trough serum concentrations drawn on day 3 after steady state achieved was significantly increased [51.0% (51/100) vs. 37.3% (53/142), P < 0.05]. Compared with the non-pharmacists intervention group, the percentages of patients who received appropriate initial dosing and attained the initial target therapeutic range in pharmacists intervention group were significantly increased [87.4% (76/87) vs. 68.2% (75/110), 51.7% (45/87) vs. 30.9% (34/110), both P < 0.01], the percentage of patients whose vancomycin dosing regimen was adjusted based on TDM results was also significantly increased [54.0% (47/87) vs. 15.5% (17/110), P < 0.01], the rate of vancomycin serum concentrations reaching the standard was increased [70.1% (61/87) vs. 32.7% (36/110), P < 0.01], and a lower number of patients in sub- or supra-therapeutic range was observed in pharmacists intervention group [27.6% (24/87) vs. 46.4% (51/110), 2.3% (2/87) vs. 20.9% (23/110), both P < 0.01]. In addition, a lower incidence of vancomycin-induced acute kidney injury (AKI) was observed in pharmacists intervention group as compared with that in non-pharmacists intervention group [0 (0/87) vs. 6.4% (7/110), P < 0.01]. No significant difference was observed in the microorganism culture, 30-day mortality rate or length of hospital stay between the two groups. Among the 87 patients in pharmacists intervention group, the vancomycin dosing was adjusted for 42 patients who did not attain the target therapeutic range, increasing the dose of vancomycin was made for 22 patients, 24-hour continuous infusion was made for 20 patients. Compared with the only increasing vancomycin dose group, vancomycin continuous infusion for 24 hours could significantly increase the serum trough concentration (mg/L: 18.0±6.7 vs. 12.5±5.8, P < 0.05), and reduce daily dosage (mg/kg: 27.1±7.1 vs. 36.6±9.2, P < 0.01). The implementation of a pharmacist-directed vancomycin dosing guideline based on TDM optimized vancomycin dosing regimen, improved the accuracy and timeliness of TDM for vancomycin, achieved a higher percentage of levels within the therapeutic range, and a lower incidence of vancomycin-induced AKI.