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1.
The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) maintains a database of extremely preterm infants known as the Generic Database (GDB). Begun in 1987, this database now includes more than 91,000 infants, most of whom are extremely preterm (<29 weeks gestation). The GDB has been the backbone of the NRN, providing high quality, prospectively collected data to study the changing epidemiology of extreme prematurity and its outcomes over time. In addition, GDB data have been used to generate hypotheses for prospective studies and to develop new clinical trials by providing information about the numbers and characteristics of available subjects and the expected event rates for conditions and complications to be studied. Since its inception, the GDB has been the basis of more than 200 publications in peer-reviewed journals, many of which have had a significant impact on the field of neonatology.  相似文献   
2.
目的:了解居民对于仿制药的认知,并探索可能影响其认知的相关因素,为设计干预措施以促进仿制药的合理替代使用提供理论支持。方法:依托全国医药信息网建立的36个分网单位,获取居民对仿制药的认知与行为意向的线上问卷调查数据。结果:15 046份问卷显示,有16.9%的居民对仿制药的概念完全不了解;13.22%的人不知道自己所使用的药物是原研药还是仿制药;64.04%的人表示接受使用任何仿制药,75.47%的人表示对于过评仿制药将接受使用。居民"使用过评仿制药的意愿"在不同地区、患慢性病种数、医保类型、性别、年龄、学历、居住地和月收入的组别中存在显著差异(P<0.05)。结论:当前中国居民对仿制药的了解和关注程度较低,认知存在偏差;相较于未过评仿制药,居民对过评仿制药更为认可。建议中国完善仿制药的科普宣传体系,在持续推进仿制药一致性评价的同时,做好过评药品临床疗效的监测工作。  相似文献   
3.
《Surgery (Oxford)》2021,39(12):778-784
The Intercollegiate Surgical Curriculum Programme (ISCP) provides the Curriculum with the specialty syllabus, trainee’s portfolio of activity, and the process and recording of assessment. It is an excellent resource and in order to gain the optimal benefit trainees and trainers are recommended to invest some time in navigating through the site and understand its functionality. The launch of the 2021 Surgical Curricula is an important change with the new assessment tool of the Multiple Consultant Report (MCR) and the trainee input with their self-assessment. The ISCP has incorporated the MCR assessment process (Generic Professional Capabilities and Capabilities in Practice) into the learning agreement structure such that the progression through to the higher-level outcome of the curriculum, defined as a day 1 consultant in a specialty, is enhanced by frequent and focussed feedback specific to the trainee. To achieve the optimal outcomes, it is important to have strong engagement with the ISCP and the useability has been enhanced to facilitate this.  相似文献   
4.
Antipsychotic reductions have been the primary focus of efforts to improve dementia care in nursing homes by the Centers for Medicare & Medicaid Services National Partnership. Although significant antipsychotic reductions have been achieved, this policy focus is myopic in 2 ways; there is no evidence for any increases in use of nonpharmacologic interventions, and there are indications for compensatory increases in the use of other (unmeasured) sedating psychotropics. This increased use of other sedating psychotropics is more concerning than the antipsychotics that they replaced, as there is even less support of efficacy for behavioral and psychological symptoms of dementia (BPSD) and ample proof of harms, including mortality. The current paradigm of “assessment” and “treatment” for BPSD is largely cursory and reflexive, with little effort put forth to understand possible underlying causes. This contrasts with the methodical, evidence-based way the field handles other symptoms considered “medical” (eg, shortness of breath). To move beyond this nonmedical approach to BPSD, we suggest a conceptual model that includes putative causal contributors. Although at their core BPSD are caused by brain circuitry disruptions, such disruptions are theorized to increase the person with dementia's vulnerability to 3 categories of triggers: those related to the (1) patient (eg, pain, hunger, and infection), (2) caregivers (eg, competing priorities, unrealistic expectations, and negative communications), and (3) environment (eg, overstimulation and limited light exposure). Assessing modifiable triggers is inherently person-centered as it enables clinicians to select specific nonpharmacologic strategies to mitigate identified triggers. Assessing triggers and selecting strategies, however, is time-intensive and reflects a paradigm shift necessitating a reorganization of dementia care including compensation for time spent elucidating and addressing modifiable triggers, vs unintendedly incentivizing the use of potentially harmful psychotropics. This paradigm shift should also include the measurement and restriction of any sedating medications for BPSD, particularly without assessment of underlying causes.  相似文献   
5.
To explore the basic mechanical properties and size effects of recycled aggregate concrete (RAC) with different substitution ratios of coarse recycled concrete aggregates (CRCAs) to replace natural coarse aggregates (NCA), the failure modes and mechanical parameters of RAC under different loading conditions including compression, splitting tensile resistance and direct shear were compared and analyzed. The conclusions drawn are as follows: the failure mechanisms of concrete with different substitution ratios of CRCAs are similar; with the increase in substitution ratio, the peak compressive stress and peak tensile stress of RAC decrease gradually, the splitting limit displacement decreases, and the splitting tensile modulus slightly increases; with the increase in the concrete cube’s side length, the peak compressive stress of RAC declines gradually, but the integrity after compression is gradually improved; and the increase in the substitution ratio of the recycled aggregate reduces the impact of the size effect on the peak compressive stress of RAC. Furthermore, an influence equation of the coupling effect of the substitution ratio and size effect on the peak compressive stress of RAC was quantitatively established. The research results are of great significance for the engineering application of RAC and the strength selection of RAC structure design.  相似文献   
6.
BackgroundThe hepatitis C virus (HCV) will only be eliminated through successful engagement with people who inject drugs (PWID), however some of this population experience socioeconomic and individual issues that can lead to poor HCV treatment adherence. A key sub-group of (PWID) are those who receive opioid substitution therapy (OST). In Australia, OST is most often delivered under direct supervision by a community pharmacist every day or multiple times a week. This regular interaction could be an ideal opportunity to enhance direct-acting antiviral (DAA) treatment adherence under directly observed therapy (DOT) by the pharmacist.AimThe aim of this study was to explore the perspectives of OST patients with a lived experience of HCV to understand whether or not dispensing DAAs in the same way as, or simultaneously with OST would benefit HCV treatment.MethodsData collection occurred from June to August 2017. Semi-structured interviews were conducted with a sample of PWID living with HCV and on OST programs (n = 12) in Melbourne, Australia. Interviews were voice recorded and transcribed in verbatim. Interpretive phenomenology guided analysis of the data.ResultsThemes reported by participants that provide insight into the suitability of DOT of DAAs include: Adherence and non-adherence to DAA treatment; Mixed views towards DOT of DAAs; Experiences and perceptions of OST providers; and Perceived stigma in the pharmacy.ConclusionsCommunity pharmacies offering OST may be an effective place for DOT of HCV treatment, but is likely only to benefit people who face significant challenges to adherence. We suggest that a positive pharmacist-patient relationship, high OST adherence, and commitment to reducing stigma in the pharmacy would be necessary for the intervention to be effective. Further research is needed to evaluate the expanded-role of community pharmacies in improving DAA adherence and eliminating HCV.  相似文献   
7.
介绍了汞污染的危害和医疗汞排放控制现状,分享了含汞医疗器械替换的成功案例,用以避免汞泄露对患者及医护人员的健康损害,以此降低医疗机构的环境影响。  相似文献   
8.
9.
等时替代模型(ISM)是探索身体行为与健康结局之间真实关联的有力工具,在大型自然人群队列研究中具有突出的应用潜力。本文系统介绍ISM的原理和具体分析中的实现方法,以期为国内身体行为相关的流行病学研究提供分析思路。通过西北区域自然人群队列研究陕西省人群基线调查数据,分别采用单一活动模型、分割模型以及ISM分析身体活动与心血管疾病的关联,比较不同模型优缺点,展示ISM在量化身体活动健康风险研究中的优势。ISM可以较好量化身体活动与健康结局的真实关联,在流行病学研究中具有广泛的应用价值。  相似文献   
10.
IntroductionThe effectiveness of the hepatitis C virus (HCV) treatment seems to be lower in people who inject drugs (PWID). We analyze the influence of various factors as psychiatric disorders and opioid substitution therapy (OST) on the treatment with direct-acting antivirals (DAA) in this collective.Patients and methodsThree hundred thirty-two PWID patients were treated with DAA in 12 Spanish hospitals between 2004 and 2020. They were catalogued in recent and former consumers (if the last consumption was in the last 3 years) and several variables were included, evaluating the effectiveness of the treatment according to the viral load 12 weeks after the end of the treatment with the parameter «sustained viral response» (SVR12).Results23.4% were recent consumers and 27.7% were on OST. The 41.5% had any diagnosis of psychiatric disorder. SVR12 was 84.04%, ascending to 96.21% when excluded from the analyses the patients lost to follow-up (12.7%). SVR12 was lower due to an increase in the loss to follow-up in recent consumers and other factors like OST, being in prison the last 5 years, naïve patients, generalized anxiety disorder and benzodiazepine consumption.ConclusionsThe effectiveness of the HCV treatment with DAA in PWID is similar than in general population in patients whit an appropriate follow-up. It is important to maintain a closer follow-up in patients on OST, recent consumers and those with psychiatric disorders.  相似文献   
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