Legal Issues in Diabetes Technologies: As the Pendulum Swings—Medical Products Class Actions Litigation in Canada: Recent Developments

During the relatively short history of class proceedings in Canada, developers and manufacturers of medical devices and pharmaceuticals (“medical products”), including medical products designed for patients with diabetes, have found themselves at the receiving end of a significant number of class action claims. As a result, medical products litigation has become the battleground for some of the most significant developments in Canadian class actions law. This article provides a broad overview of some of the most significant developments. The authors pay particular attention to developments regarding the test for class action certification and consider whether high-profile dismissals of certification motions represent a trend toward raising the threshold for plaintiffs seeking to obtain certification of a proposed class action. The authors also consider a decision arising out of a lengthy class action common issues trial in which the medical device company was victorious. In the authors’ view, the class action pendulum in Canada, particularly as it relates to medical products claims, remains in motion. It behooves all affected players to keep their eye on this ball with rapt attention to see where it may move next.     

急诊内科应用APACHEⅡ与SAPSⅡ评分在对患者重症评估时的价值比较

目的比较急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)与简化急性生理学评分系统Ⅱ(SAPSⅡ)在临床急诊内科重症患者评估时的临床价值差异。方法收集本院2011年～2012年急诊内科收治的重症患者157例的临床资料,分别依据APACHEⅡ评分系统和SAPSⅡ系统对其预计病死率进行预计,并与真实病死率进行比较。结果两组患者的APACHEⅡ和SAPSⅡ评分和预计病死率方面均以死亡组较高(P<0.01),且SAPSⅡ评分法计算的两组预计死亡概率均高于APACHEⅡ法(P<0.05),两种分析方法的AUROCC分别为0.874和0.798(P<0.05)。随着入院时分值增加,病死率亦增加,且SAPSⅡ预计病死率高于实际病死率(P<0.05)。结论两种评价系统均适用于急诊内科重症患者的评估,其中APACHEⅡ校准度高,宜为首选。     

团体干预在改善护理专业学生对精神病公众污名态度中的效果评价

目的评价团体干预在改善护理专业学生对精神病公众污名态度方面的效果。方法采用类实验性研究,选取符合纳入标准的护理专业在校生110名作为干预对象,采用随机数字表法分为对照组(55名)和观察组(55名),观察组在对照组常规干预的基础上实施团体干预,采用精神病公众污名量表和社交距离量表进行评估,比较干预前、干预后0月、干预后1个月、干预后3个月数据结果。结果时间因素或干预因素引起污名、接纳及社交距离量表得分的差异均具有统计学意义(P0.05),且得分在时间效应和干预效应之间存在交互作用(P0.01)。结论团体干预能够改善护理专业学生对精神病患者污名的态度,促进其对患者的接纳及缩短其与患者的社交距离,且干预后态度及行为的改变能够保持一定的时间。     

基于真实世界的脉络舒通丸对肝功能指标影响的研究

目的 应用医院信息医疗系统电子数据开展真实世界脉络舒通丸对肝功能指标影响的安全性临床研究。方法 基于全国14家大型三级甲等医院的医疗电子数据库，将服用脉络舒通丸患者作为脉络舒通丸组，未服用脉络舒通丸者作为对照组，以性别相同、年龄±5岁为匹配条件，按照1∶1比例分组后2组均为2387例，以用药后肝功能指标[碱性磷酸酶（alkaline phosphatase,ALP）、丙氨酸氨基转移酶（alanine transaminase,ALT）、天冬氨酸氨基转移酶（aspartate transaminase,AST）、谷氨酞转移酶（gamma-glutamyl transferase,GGT）、总胆红素（total bilirubin,TBIL）]作为结局评价指标，通过倾向性评分方法控制研究中存在的混杂因素，采用3种统计学方法进行安全性分析。结果 筛选出12个影响程度较高的混杂因素，加权平衡了全部的混杂因素，3种统计学方法得到的结果均为P>0.05，两组差异不具有统计学意义。结论 不能认为脉络舒通丸导致肝功能指标异常变化，但鉴于倾向性评分法仅能控制已知潜在混杂因素，无法实现对未知混杂因素...     

Method for Simultaneous Determination of Free Concentration,Total Concentration,and Plasma Binding Capacity in Clinical Samples

Most quantitative research methods are based on measuring either the total or the free concentration of an analyte in a sample. However, this is often insufficient for the study of complex biological systems. The main objective of this research was to develop new methods for providing more information from samples: the free concentration (C_f), the total concentration (C_t), and the plasma binding capacity (PBC). Samples were processed using microextraction and ultrafiltration. For each of these techniques, two quantification procedures were used: addition of isotopically labeled standard and repeated analysis of the same sample. The new methods were validated by analyzing clinical samples and samples with known concentrations. Methods based on addition of labeled compound were found to be the fastest, and most reproducible. For analysis of clinical samples, methods based on microextraction were more sensitive and more accurate than those based on ultrafiltration. For analysis of pooled plasma samples, the overall accuracy of all approaches to determine PBC, testosterone C_f, and testosterone C_t was between 94 and 109%, 87–113%, and 94–122% respectively. The new approach goes beyond a simple concentration measurement, giving more information from clinical samples, with great potential for personalizing drug dosage and therapy to the needs of individual patients.     

爱情满意度与包容及情商的关系

目的 探讨爱情满意度与包容力以及情商的关系,找出提高爱情满意度的方法.方法 使用包容力测试、EQ测试与爱情满意度问卷对870位在校大学生进行调查研究.结果 不同性别之间在爱情满意度上没有显著差异,但是在情商和包容力上却差异显著(t=2.543,P＜0.05；t=5.358,P＜0.01).是否是独生子女、不同的年级和不同的年龄之间,爱情满意度、情商和包容力没有显著的差异.爱情满意度与包容力和情商之间的相关关系十分微弱(r=-0.142,0.161).结论 更多包容和更高情商并不会带来更满意的爱情,而是需要双方积极和良好的沟通才能把存在的问题和矛盾化解.     

Pharmacological thrombolysis: the last choice for salvaging free flaps

Abstract

Microvascular free flap transfer has become a prevailing surgery with a failure rate of <5%. However, pedicle thrombosis occurs more frequently than indicated by the failure rate. This difference is due to the successful salvage of failing flaps. During exploration, thrombi are often encountered at anastomotic sites, whereas these causes could not explain vascular compromise in other patients. Thus, we hypothesized that thrombogenic processes might occur at remote sites, specifically within microvessels of the transferred flap. This study retrospectively evaluated 323 patients who underwent microvascular free flap transfer between March 2012 and October 2016 at Korea University Guro Hospital. All patients requiring emergency exploration within 7?days after surgery were retrospectively reviewed. Of patients, 15 required explorative surgery for suspected circulatory compromise. Eight were diagnosed with thrombosis at the perianastomotic site and salvaged in accordance with our protocol. There was no detectable thrombosis at the anastomotic site in seven patients, including one patient in whom thrombosis resolved with topical papaverine application and heparinization. The remaining six patients were diagnosed with intra-flap microthrombosis without discernable thrombosis at the anastomotic site. All patients were treated following our urokinase administration protocol and salvaged without complications. Possible external causes should first be evaluated when salvaging free flaps; in the absence of such evidence, urokinase administration may be utilized as a last resort. This study is the first report describing the effectiveness of pharmacological thrombolysis in resolving intra-flap microthrombosis. Furthermore, a safe and efficient urokinase administration protocol is suggested for perianastomotic thrombosis and intra-flap microthrombosis.     

Perceptions of Family Physician Trainees and Trainers Regarding the Usefulness of a Virtual Community of Practice

BackgroundTraining for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training.ObjectiveThis study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable.MethodsA survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia’s 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4).ResultsMost respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network.ConclusionsGeneral practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness.     

Pediatrics: Benefits of Hospitalizing Mother with Child

The use of hospitalists—physicians who limit their practice largely or exclusively to hospital inpatient care—has been a growing trend in the United States. The authors examine some pressures affecting an academic medical center and present the results of a hospitalist pilot project there. Based on the criteria of reduced patient length of hospital stay, hospital financial savings, physician satisfaction, and payer interest, the pilot hospitalist program was successful within 6 months.     

A Curriculum in Agricultural Medicine for Medical Students

A variety of educational programs in occupational medicine are available for medical students. This paper describes a two-day program that emphasizes agricultural medicine for senior medical students during their rotation in the Department of Family Medicine at the Medical University of South Carolina. The program uses interactive case discussions and farm visits as tools for motivating students to pursue further experience in the field.