Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial

AimsCurrent follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design.Materials and methodsOnline focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis.ResultsEight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up – lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence – and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals.ConclusionsClinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.     

“医信融合”视域下复合型医学人才培养目标及效果评价

培养“医信融合”复合型医学人才是医学高等教育在新时代信息技术发展背景下的历史使命。在引入“医信融合”教育理念的基础上，提出“医信融合”教育的人才培养目标及其内容体系，并据此构建了“医信融合”人才培养质量评价指标，提出了培养效果评价方法。介绍“医信融合”教育人才培养效果的评价方法，对山西医科大学“医信融合”教学效果进行实证分析，从而为“医信融合”教育实践提供借鉴。     

562名医务人员子女心理行为状况调查

目的 了解儿童心理行为状况,为改善儿童心理行为问题提供依据。方法 针对本院医务人员子女采用整群随机抽样的方法,通过手机端发放长处和困难问卷(Strengths and Difficulties Questionnaire,SDQ)电子版进行调查,收集儿童心理行为健康相关信息。结果 本研究纳入观察病例共562份,年龄均值(8.06±3.251)岁。其中,男275名(48.9%),女287名(51.1%);学龄期儿童311名(55.3%),学龄前期儿童251名(44.7%)。SDQ困难总分评定异常者12.9%,边缘状态者18.1%,正常者69%。情绪问题 、品行问题 、同伴关系问题 、多动问题 、困难总分、亲社会行为各因子异常检出率分别为9.6%、9.8%、19.2%、18.1%、12.9%、7.8%。不同性别儿童SDQ困难总分、情绪症状、亲社会行为、品行问题差异无统计学意义(P>0.05)。男生多动问题、同伴关系问题评分分别为(3.87±1.471)分、(4.53±1.542)分,分别高于女生的(3.65±1.415)分、(4.31±1.554)分,差异有统计学意义(t=0.96、7.65,P<0.05)。学龄前期儿童与学龄期儿童情绪症状、品行问题、亲社会行为差异无统计学意义(P>0.05)。学龄期儿童同伴关系问题、多动问题、困难总分评分分别为(4.53±1.507)分、(3.85±1.298)分、(12.15±3.613)分,分别高于学龄前期儿童的(4.26±1.652)分、(3.54±1.402)分、(11.45±4.39)分,差异有统计学意义(t=5.36、6.57、14.32,P<0.05)。结论 调查发现,本院医务人员子女心理行为问题发生率较高。应进一步核实诊断,根据不同的心理特征及年龄分类,及早给予心理支持和干预,并由心理医生对这一群体进行长期随访。     

Zhang Weishen: A Pioneer in the Development and Industrial Production of Penicillin in New China

The research and development of penicillin started with difficulty before 1949 and achieved certain results. In 1951, after the founding of the People's Republic of China, Zhang Weishen, as the only Chinese scientist who had been trained and worked in a penicillin research and development center in the United States for many years, overcame many difficulties and returned to China. In 1953, with the efforts of Zhang Weishen and his colleagues, China realized the industrialized production of penicillin, alleviating the urgent needs of the masses. Antibiotics has also become the first discipline to achieve major scientific and technological achievements after the founding of the New China. In the mid-1950s, the technical breakthrough in the localization of lactose substitutes marked the localization of the raw materials of the penicillin-producing culture medium, which paved the way for the industrialized production of penicillin with Chinese characteristics. Antibiotics have become one of the most widely used and affordable drugs for hundreds of millions of patients in China, and China has since ended the humiliating history of the “Sick Man of East Asia".     

Professional Steps: The Certification Path

Obtaining certification is a critical step on the road to professionalism. There are many questions to consider in this decision. Included among these are cost, preparation, and return on the investment. Important answers to these questions are discussed.     

A candidate multi-epitope vaccine against porcine reproductive and respiratory syndrome virus and Mycoplasma hyopneumoniae induces robust humoral and cellular response in mice

Porcine reproductive and respiratory syndrome virus (PRRSV) and Mycoplasma hyopneumoniae (M. hyopneumoniae, Mhp) are two of the most common pathogens involved in the porcine respiratory disease complex (PRDC) resulting in significant economic losses worldwide. Vaccination is the most effective approach to disease prevention. Since PRRSV and Mhp co-infections are very common, an efficient dual vaccine against these pathogens is required for the global swine industry. Compared with traditional vaccines, multi-epitope vaccines have several advantages, they are comparatively easy to produce and construct, are chemically stable, and do not have an infectious potential. In this study, to develop a safe and effective vaccine, B cell and T cell epitopes of PRRSV-GP5, PRRSV-M, Mhp-P46, and Mhp-P65 protein had been screened to construct a recombinant epitope protein rEP-PM that has good hydrophilicity, strong antigenicity, and high surface accessibility, and each epitope is independent and complete. After immunization in mice, rEP-PM could induce the production of high levels of antibodies, and it had good immunoreactivity with anti-rEP-PM, anti-PRRSV, and anti-Mhp antibodies. The anti-rEP-PM antibody specifically recognizes proteins from PRRSV and Mhp. Moreover, rEP-PM induced a Th1-dominant cellular immune response in mice. Our results showed that the rEP-PM protein could be a potential candidate for the development of a safe and effective multi-epitope peptide combined vaccine to control PRRSV and Mhp infections.     

Vaccine innovation model: A technology transfer perspective in pandemic contexts

This work identifies the innovations that made it possible for the Bio-Manguinhos/Fiocruz Immunobiological Technology Institute to engage in the entire production of the Oxford/AstraZeneca vaccine (ChAdOx1 nCov-19) in Brazil, just 1.8 years after the COVID-19 pandemic was declared. The results were summarized in a case-based innovation model composed of 11 workstreams, 32 stages, 22 gates, 11 innovations, and 38 events. In terms of research contributions, three were found: (i) the identification of firm and government-level innovations allowing the substantial reduction in the COVID-19 vaccine time-to-market in Brazil; (ii) the presentation of empirical evidence supporting the new Outbreak Paradigm for vaccine research, development, and production; and (iii) the proposition of a conceptual model for describing innovations through the vaccine value chain in pandemic contexts, particularly when technology transfer is involved.     

Ovine Iliac Vein Model for Endovascular Thrombectomy of Acute Deep Venous Thrombosis

An ovine iliac vein thrombosis model was devised to test a wall-contacting rotational thrombectomy device. Thrombosis was successfully induced in 9 sheep with an average clot length of 31 mm ± 12 and >60% vessel occlusion on angiography. The thrombus was subsequently removed, maintaining normal intraoperative pulmonary arterial pressure (5.9 mm Hg ± 3.6) and complete distal reperfusion after thrombectomy. Additionally, the sheep were without signs of vascular trauma or embolic complications on gross necropsy and histopathologic analysis. The findings from this study support the use of an ovine iliac deep vein thrombosis model for testing of a lower extremity thrombectomy device.