A Tool to Assess Patient and Surrogate Knowledge About the POLST (Physician Orders for Life-Sustaining Treatment) Program

ContextIt is especially important that patients are well informed when making high-stakes, preference-sensitive decisions like those on the Physician Orders for Life-Sustaining Treatment (POLST) form. However, there is currently no way to easily evaluate whether patients understand key concepts when making these important decisions.ObjectivesTo develop a POLST knowledge survey.MethodsExpert (n = 62) ratings of key POLST facts were used to select items for a POLST knowledge survey. The survey was administered to nursing facility residents (n = 97) and surrogate decision-makers (n = 112). A subset (n = 135) were re-administered the survey after a standardized advance care planning discussion to assess the scale's responsiveness to change.ResultsThe 19-item survey demonstrated adequate reliability (α = 0.72.). Residents' scores (x = 11.4, standard deviation 3.3) were significantly lower than surrogate scores (x = 14.7, standard deviation 2.5) (P < 0.001). Scores for both groups increased significantly after administration of a standardized advance care planning discussion (P < 0.001). Although being a surrogate, age, race, education, cognitive functioning, and health literacy were significantly associated with higher POLST Knowledge Survey scores in univariate analyses, only being a surrogate (P < 0.001) and being white (P = 0.028) remained significantly associated with higher scores in multivariate analyses.ConclusionThe 19-item POLST Knowledge Survey demonstrated adequate reliability and responsiveness to change. Findings suggest the survey could be used to identify knowledge deficits and provide targeted education to ensure adequate understanding of key clinical decisions when completing POLST.     

甘肃省和政县农村老年性白内障防盲项目的卫生经济学评价研究

目的 对2014-2016年在甘肃省和政县开展的白内障综合防盲干预项目进行卫生经济学评价。设计 横断面调查。 研究对象 甘肃省和政县2014-2016年老年性白内障手术前407例患者及术后半年109例患者。方法 对所有调查对象进行卫生经济学问卷调查。通过净效益法、成本效益分析法和成本效果分析法评价项目产生的经济效益和总成本。主要指标 直接成本、间接成本、直接经济效益、间接经济效益、总成本、总效益、净效益、成本效益比、成本效果比。结果 2014-2016年项目期间甘肃省和政县白内障所致总体疾病经济负担为2142.28万元。白内障手术产生的总效益为3398424.98元，总成本为2939125.20元，净效益为459299.78元，效益成本比为1.16:1。项目每投入1万元可降低50岁以上白内障患者导致的0.027%的致盲率和0.164%致残率；项目每降低1%的50岁以上白内障患者的盲率，需投入36.47万元；每降低1%50岁以上白内障患者的残率，需投入6.11万元。结论 在甘肃省和政县开展的老年性白内障防盲综合干预项目具有较好的产出回报比和较高的防盲技术效率。（眼科，2020，29： 298-303）     

Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment

Abstract

Objective

Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients’ preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies.     

Clinicopathologic characteristics of paranasal sinus fungus ball: retrospective,multicenter study in Korea

European Archives of Oto-Rhino-Laryngology - Fungus ball (FB) is the most common type of fungal rhinosinusitis and the prevalence of FB has increased over the past 10&nbsp;years. The aim of...     

佛山市乙型肝炎母婴阻断工作环节问题探讨

目的探讨佛山市乙肝母婴阻断工作中存在的问题，为完善进一步工作提供思路。 方法采用队列研究的方法，以2017年佛山市HBsAg阳性产妇13 672例及其所分娩13 982例活产儿为研究对象，通过回顾性病历采集及前瞻性的随访追踪的方法，全面了解影响乙肝母婴阻断工作的主要因素。 结果2017年佛山市产妇HBsAg阳性率为10.14%，感染孕妇中HBeAg阳性率为24.13%，孕期HBV DNA检测率约5%，其中抗病毒治疗63例；新生儿乙肝免疫球蛋白接种率为99.84%；婴儿在出生后1年内完成乙肝疫苗三针接种的比率为81.71%，在完成三针乙肝疫苗接种的儿童中按照0-1-6程序接种的比率为62.65%；母婴阻断结果追踪率为40.16%，追踪儿童中母婴阻断失败34例，失败率为0.61%；产妇年龄低、HBeAg阳性、HepB未全程及规范接种是母婴阻断失败的危险因素(P<0.05)。儿童明确未检测的主要原因是拒绝检查、不知道要检查、提前检查和检测未提供结果，占99.07%。 结论加强信息沟通及健康教育，落实乙肝病毒感染产妇孕期DNA检测及抗病毒治疗，提高儿童乙肝疫苗的规范接种率，将暴露儿童的乙肝两对半检测纳入儿童保健管理工作，是实现全市乙肝母婴零传播的重要措施。     

从GAMP的理念谈制药行业自动化工程建设与验证的有关问题

根据国际药物工程协会(ISPE)所提GAMP的理念,谈有关制药行业自动化工程建设与验证方面的问题,其中包括GAMP的基本思想与概念、制药行业自动化工程建设与验证关系问题以及我国制药行业自动化工程建设与验证所存在的问题。