Variation among state-level approaches to addressing alcohol abuse in opioid treatment programs

In view of their role in licensing opioid treatment programs (OTPs), state opioid treatment authorities (SOTAs) are in a unique position to influence how OTPs address their patients' alcohol abuse. Using data from a telephone survey of SOTAs from the District of Columbia and states that have at least one OTP (n = 46), this study examines the extent to which SOTAs address alcohol abuse in their respective state policies and guidelines for OTPs. Findings indicate that 27 states have overall measures on how to address patients' problematic alcohol use, 23 states require or recommend alcohol education to be provided to all patients, and 17 states have stipulations that address specific actions to be taken if patients present at daily dosing under the influence of alcohol. Although SOTAs generally rate alcohol of at least moderate importance in formulating regulations, many of their policies and guidelines do not deal with various alcohol-related services and issues.     

Generic drug approval: A US perspective

Abstract

Objective:

Generic drugs are identical or bioequivalent versions of the brand name drugs. They are the economic alternative of the costlier brand name drugs. This article presents a general overview of the procedure and regulatory aspects relating to generic drug approval in the US.     

门诊实名制预约挂号的实践与对策初探

目的 探讨门诊实名制预约挂号的实践意义,为患者就医提供方便.方法 2011年10月开始对本院门诊挂号实施实名制预约挂号方式,为患者提供电话专线、网络预订等多种预约门诊挂号途径,并细化、合理安排专家门诊类型.通过发放问卷,调查2011年10月～2012年10月的患者对实名制预约挂号的了解以及受益情况.结果 ①1年中各季度预约门诊量逐渐提高,201 1年10～12月预约量占总门诊量的14.2％,2012年7～10月初则达到26.1％,预约量明显提高（P＜0.05）,复诊患者的人数占总预约门诊人数的10.1％;②患者对实名制预约挂号和普通挂号区别的认知情况较差,认知度为30.0％,预约方式中患者首选诊间预约（38.3％）,而网络预约选择较少,患者对实名制预约挂号的满意度达71.7％.结论 门诊实名制预约挂号是突破顽固思想的新举动,充分发挥信息时代的优势,解决患者就诊的基本问题,社会效益良好.     

近10年国内针灸临床试验研究病种计量分析

为了解近年来国内针灸临床试验研究中涉及的病种情况,并且与之前国外针灸临床试验研究的结果进行对比,本研究采用文献计量的方法,通过对中国中医药期刊文献数据库收录的近10年(2003年至2012年)的针灸临床试验研究的文献进行调研,得出有关中西医疾病病名的主题词1187个,并列举其中排名前100位的高频词。与国内外前期的研究报道进行比较,认为国内针灸临床研究涉及的疾病种类远远超过国外,并且在不断扩充。     

The role of the slope of oxygen consumption and EMG activity on freely chosen pedal rate selection

The objective of this study was to verify the following hypothesis: the pedal rate that minimizes root mean square (RMS) slope and the slow component amplitude of oxygen consumption could be close to the freely chosen pedal rate (FCPR) used by well-trained cyclists. Nine male competitive cyclists performed a 21 min submaximal exercise on a cycle ergometer at a workload of 65% of their respective peak aerobic power. For each session, the subject's pedal rate was freely chosen or assigned to 60, 75, 90 or 105 rev min(-1). When pedal rates were imposed, the electromyographic root mean square slope, the oxygen uptake during the third minute and the 20th min, and the slow component amplitude of oxygen consumption were used in the analysis. In order to determine the optimal pedal rate (OPR), a quadratic function was fitted to the data by regression, for each variable measured. The mean values of OPR relative to oxygen uptake during the third min (71+/-9 rev min(-1)) were lower than the mean values of the OPR relative to the slow component amplitude of oxygen consumption (82+/-8 rev min(-1)), the electromyographic root mean square slope (80+/-7 rev min(-1)) and freely chosen pedal rate (86+/-13 rev min(-1)). Freely chosen pedal rate was not significantly different from the OPR in reference to the amplitude of the slow component of oxygen consumption, electromyographic root mean square slope, and oxygen uptake during the 20th min. OPR for RMS slope was correlated (R=0.72) to FCPR. Expert cyclists were likely to use a spontaneous pedal rate that minimizes neuromuscular fatigue.     

高海拔地区官兵实名和匿名心理状况调查结果的差异

目的探讨实名和匿名调查方法测试高海拔地区官兵心理健康状况的准确性。方法采用症状自评量表（SCL-90）对驻守在高海拔地区的两部边防官兵进行实名和匿名心理测试,两部官兵测试结果进行比较,并分别与成人常模比较。结果采用实名心理测试的甲部官兵与成人常模比较,除躯体化因子分值差异无统计学意义（P〉0．05）外,余各项因子分值均明显低于成人常模,差异有统计学意义（P〈0．01）。采用匿名心理测试的乙部官兵与成人常模比较,躯体化、抑郁、焦虑、敌对、恐怖、精神病因子分值明显高于成人常模,人际关系敏感因子分值低于成人常模,差异有统计学意义（P〈0．01,P〈0．05）。采用实名心理测试的甲部官兵SCL-90各项因子所得分值均明显低于采用匿名心理测试的乙部官兵,差异有统计学意义（P〈0．01）。结论对官兵进行实名心理测试可能影响测试准确性,建议高海拔地区官兵采用匿名方法进行心理测试。     

中医临床研究数据中心构建模式探讨

为促进中医药事业发展,创新中医临床科研模式,实现中医临床研究数据共享,为广大医护、研究人员提供海量信息支撑,构建中医临床研究数据中心是实现创新型中医临床研究的重要手段之一。对中医临床研究数据中心构建模式进行了探讨,从中医临床研究数据的分层管理模式出发,阐述了国家数据中心与医院数据中心的关系;介绍了医院数据中心的构建方式,并探讨医院数据中心与医院信息中心的数据交互方式,以及协作单位的数据整合方式等;通过国家与医院数据中心的互联,实现了中医临床研究数据跨区域共享：通过对数据存取流程的分析,阐述了中医临床数据中心数据的传输方式。     

Metrics and management: Two unresolved problems on the pathway to health care-associated infection elimination

Surveillance and management of health care-associated infections (HAIs) has traditionally relied on analyses of outcome data to elucidate trends in HAI incidence, discover host or treatment risk factors, and facilitate comparisons of HAI rates within and among licensed providers or facilities. This paper explores residual gaps and shortcomings associated with outcome reporting and possible sources of bias that may invalidate intra- and interfacility comparisons. As an alternative to outcome surveillance and reporting, real-time process monitoring and control is proposed. To address the need for uncompromising conformity with preventive measures, the concepts of social entropy, authority, responsibility, and accountability are explored and linked to process control at the bedside.     

Embolic protection in carotid artery stenting: new options

Carotid artery stenting (CAS) has emerged as an attractive alternative to carotid endarterectomy (CEA) in patients with carotid disease who are at high risk for CEA. With increasing experience and improved technique, results in CAS patients have improved consistently over time in several clinical trials. Carotid stenting is clearly not inferior to CEA in appropriately selected high-CEA-risk patients treated by experienced operators. With improving results, CAS now has the potential to be considered "front-line therapy" even in standard-risk CEA patients, as demonstrated in CREST and as being studied in ongoing trials, such as the ACT I trial. Successful, low-risk CAS can only be performed if distal embolization is minimized during this procedure. This can be accomplished only with appropriate patient and case selection, adequate operator training and experience, and meticulous attention to procedural detail. Embolic protection devices (EPDs) are an important cornerstone of low-risk CAS. There are well-established, study-validated embolic protection systems available for CAS. Four new EPD options have been introduced in the United States over the past 3 years. Results with these newer devices appear to be extremely promising, with low event rates seen in high-risk clinical patients. This article will offer a practical review of techniques to decrease distal embolization during CAS. We will review patient selection and provide a "cookbook" approach to procedural technique, emphasizing techniques unique to each of the various EPD systems currently available. We will also introduce the newer options in EPDs, provide practical tips on their use, and contrast their use and results with that of the existing EPD systems. We will provide practical procedural techniques that incorporate the use of various EPDs into strategies that will reduce distal embolization during CAS and also provide pertinent data referencing results of these devices seen in clinical trials.     

The role of embolic protection in peripheral arterial atherectomy

Embolic protection devices were initially developed for use in the treatment of saphenous vein aortocoronary bypass graft stenosis as well as in carotid artery stenting because of the significant risk of atheroembolism and their use is well accepted. The use of these devices for lower-extremity arterial interventions is becoming well accepted because of the significant consequences of embolization in patients with limited circulatory runoff. This is especially true in the use of mechanical atherectomy devices for femoropopliteal arterial lesions.