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Aims We conducted a systematic review of studies reporting seroincidence of hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified published and unpublished studies that met inclusion criteria. Design We estimated the relative contributions of shared syringes and drug preparation equipment to HCV transmission using random‐effects meta‐analysis, and analyzed potential sources of heterogeneity of effects among studies. Findings Syringe sharing was associated with HCV seroconversion [pooled risk ratio (PRR) = 1.94, 95% confidence interval (CI) 1.53, 2.46], as was sharing drug preparation containers (PRR = 2.42, 95% CI 1.89, 3.10), filters (PRR = 2.61, 95% CI 1.91, 3.56), rinse water (PRR = 1.98, 95% CI 1.54, 2.56), combinations of this equipment (PRR = 2.24, 95% CI 1.28, 3.93) and ‘backloading’, a syringe‐mediated form of sharing prepared drugs (PRR = 1.86, 95% CI 1.41, 2.44). Meta‐regression results showed that the association between syringe sharing and seroconversion was modified by HCV seroprevalence in the IDU populations. Conclusions The risk of hepatitis C infection through shared syringes is dependent upon hepatitis C infection seroprevalence in the population. The risk of hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Because the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide or inject drugs and avoid backloading with an unsterile syringe. 相似文献
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P. Bouzat C. Broux F.X. Ageron F. Thony C. Arvieux J. Tonetti E. Gay E. Rancurel J.F. Payen 《Annales fran?aises d'anesthèsie et de rèanimation》2013,32(7-8):531-534
Survival after severe trauma may depend on a structured chain of care from the management at the scene of trauma to hospital care and rehabilitation. In the USA, the trauma system is organized according to a pre-hospital triage by paramedics to facilitate the admission of patients to tertiary trauma centres. In France, trauma patients are transported to the most suitable facility, according to the on-scene triage by an emergency physician. Because French hospital's resources become scarce and expensive, the access to all techniques of resuscitation after severe trauma is restricted to tertiary trauma centres, at the expense of prolonged duration of transfer to these centres with a possible impact on mortality. The Northern French Alps Emergency Network created a regional trauma network system in 2008. This organization was based upon the interplay between the resources of each hospital participating to the network and the categorization of trauma severity at the scene. A regional registry allows the assessment of trauma system, which has included 3,690 severe trauma patients within the past 3 years. Bystanders, medical call dispatch centres, and interdisciplinary trauma team should form a structured and continuous chain of care to allocate each severe trauma patient to the best place of treatment. 相似文献
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S. E. Gentry A. B. Massie S. W. Cheek K. L. Lentine E. H. Chow C. E. Wickliffe N. Dzebashvili P. R. Salvalaggio M. A. Schnitzler D. A. Axelrod D. L. Segev 《American journal of transplantation》2013,13(8):2052-2058
Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90‐day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimized maps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28 063 liver transplant candidates, and 242 727 Model of End‐Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States. 相似文献
66.
P. S. Brazio R. N. Barth B. Bojovic A. H. Dorafshar J. P. Garcia E. N. Brown S. T. Bartlett E. D. Rodriguez 《American journal of transplantation》2013,13(10):2743-2749
Procurement of a facial vascularized composite allograft (VCA) should allow concurrent procurement of all solid organs and ensure their integrity. Because full facial procurement is time–intensive, “simultaneous–start” procurement could entail VCA ischemia over 12 h. We procured a total face osteomyocutaneous VCA from a brain–dead donor. Bedside tracheostomy and facial mask impression were performed preoperative day 1. Solid organ recovery included heart, lungs, liver, kidneys, and pancreas. Facial dissection time was 12 h over 15 h to diminish ischemia while awaiting recipient preparation. Solid organ recovery began at 13.5 h, during midfacial osteotomies, and concluded immediately after facial explantation. Facial thoracic and abdominal teams worked concurrently. Estimated blood loss was 1300 mL, requiring five units of pRBC and two units FFP. Urine output, MAP, pH and PaO2 remained normal. All organs had good postoperative function. We propose an algorithm that allows “face first, concurrent completion” recovery of a complex facial VCA by planning multiple pathways to expedient recovery of vital organs in the event of clinical instability. Beginning the recipient operation earlier may reduce waiting time due to extensive recipient scarring causing difficult dissection. 相似文献
67.
Research on the sharing mechanism of drug price information in China- from the perspective of intergovernmental information sharing 下载免费PDF全文
Establishment of sharing mechanism for drug price information to guarantee the construction of a unified cross-departmental price information platform is a new national policy after Chinese government abandoned drug price control. Based on the theory of intergovernmental information sharing, this study aimed to investigate the drug price information sharing mechanism in China through literature research and stakeholder interviews, which included institution guarantee mechanism, department coordination mechanism and technical support mechanism. 相似文献
68.
2015年安徽省精神卫生资源状况分析 总被引:1,自引:0,他引:1
目的 了解2015年安徽省精神卫生资源状况,为本省精神卫生服务资源合理配置提供理论依据。方法 收集2016年8 ~9月安徽省各地市精神卫生工作项目承担单位资源调查员填写的《2015年全国精神卫生资源调查表》(调查表数据截至2015年12月31日)。对调查表中全省精神卫生机构数、精神科执业医师数、精神科编制床位数等数据进行总结并做描述性分析。结果 截至2015年12月31日批复成立的精神卫生机构全省共有58家,编制床位数7 957张。全省精神科床位密度平均为1.31张/万人,铜陵最高为4.47张/万人,亳州最低仅为0.16张/万人。精神科执业(助理)医师891名,全省精神科医师密度平均为1.46名/10万人,铜陵最高为6.37名/10万人,滁州最低为0.45名/10万人。全省精神科患者平均住院日为(68.48±56.90)d。结论 安徽省精神卫生资源分布不均,精神卫生机构建设不足,精神科执业医师紧缺。 相似文献
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70.
建设大型仪器共享平台是我国实施创新驱动战略的重要内容,是新时代我国高等教育学校的重要使命。地方高校作为我国高等教育事业主体更应积极响应国家号召,探索和实践特色大型仪器共享平台建设之路。笔者分析了地方高校大型仪器共享平台建设现状及存在问题,并以温州医科大学为例,总结了大型仪器共享平台建设过程中实验室安全“一体化”管理、“共享平台3+”搭建和平台技术队伍建设三方面的创新举措,以期对地方高校大型仪器共享平台建设有所裨益。 相似文献