Contributions of the NICHD neonatal research network's generic database to documenting and advancing the outcomes of extremely preterm infants

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.     

Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

Benefits of positron emission tomography scans for the evaluation of radiotherapy

The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (¹⁸F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (¹⁸F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.     

我国放射卫生信息化建设现状与展望

自2009年国家个人剂量登记系统应用以来，我国放射卫生信息化建设已走过10个年头，建立了全国放射卫生信息平台，涵盖个人剂量、职业性放射性疾病与职业健康、医用辐射防护、食品放射性核素监测、职业性放射性疾病报告5个系统，截至2018年，采集监测数据800余万条，平台授权用户1 400余名。本文就10年来我国放射卫生信息化建设的现状进行分析与总结，探讨放射卫生信息化发展的重点和难点，提出建议等，以期推进放射卫生信息化建设工作，更好地为职业性放射性疾病的预防与控制服务，助力"健康中国"建设。     

Action Production and Event Perception as Routine Sequential Behaviors

It is argued that event perception and routine sequential action production share a range of characteristics (e.g., similar levels of automaticity, the involvement of sequentially and hierarchically organized schemata, and the coupled operation of predictive and monitoring processes). With this in mind, and in an effort to develop a mechanistic account of event perception, we consider how an existing model of routine sequential action production might be applied in the domain of event perception. We focus the discussion on the multiple roles of prediction in the two domains, and we consider the implications of the application of the model of action production to event perception and for sequential processing more generally.     

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

The polio vaccination story of Pakistan

BackgroundTo describe in chronological detail Pakistan’s decades long battle against poliovirus and evaluate the multiple factors impacting it.Main bodyPakistan’s fight is documented through various published research articles and reports on Pakistan’s progress in eradication of polio published by international agencies involved in elimination of poliovirus worldwide. The socioeconomic, religious, and political factors, violent religious militancy, conspiracy theories resulting in vaccine refusals are documented in detail emphasizing the ups and downs in the fight at different times since 1994 to present. Pakistan and Afghanistan are the only two countries in the world reporting cases caused by wild polio virus type 1 (WPV1) since 2017 and the only two countries that have never stopped the transmission of WPV1 Pakistan needs to work on a war footing to eliminate the disease. The need to act urgently is now being increasingly recognized by the Pakistani Government.ConclusionMany difficulties still remain. Pakistan has reached a critical stage in the fight against polio. The world will not accept any further delay or complacency as there is apprehension around the world that Pakistan may “export” polio to other countries and undermine the worldwide success in eradicating polio.     

Promoting learning on reintegration of children into family-based care: implications for monitoring approaches and tools. Experiences from the RISE learning network

ABSTRACT

Between 2015 and 2018, the RISE Learning Network facilitated learning on approaches, practices, methods, and tools that promote recovery and reintegration of children affected by sexual exploitation. Spanning three regions (Sub-Saharan Africa, South Central Asia, and Latin America and the Caribbean), the RISE Learning Network implemented two learning projects. The first project focused on monitoring (M&E Learning Project) and aimed to generate understanding of approaches and tools that could effectively monitor children and families’ reintegration outcomes. The specific purpose of RISE is to promote learning on reintegration of children affected by sexual exploitation; however, the remit of this Learning Project was to generate evidence on the reintegration of children who have been separated from their families for a range of reasons. This is to ensure that learning from different, but often related, areas of work can be included and compared to strengthen understanding of what successful reintegration of children could look like. The mid- and end-term reviews of the M&E Learning Project have captured lessons learned on how practitioners can approach monitoring of reintegration to mainstream it into their programme cycle. Key lessons learned include the importance of focusing on monitoring outcomes through participatory tools and the benefit of flexible, peer-to-peer learning approaches between practitioners using a variety of monitoring tools. This learning contributes to the nascent evidence base on what effective and efficient capturing of reintegration outcomes on children can look like, in addition to strengthening understanding of what successful reintegration for children and families means. The learnings can inform programming; monitoring, evaluation and learning frameworks; and other interventions around reintegration to ensure the holistic wellbeing of children and families.     

中国医疗不良事件报告与质量改进的分析研究

文章分析了来自国家卫生健康委员会医政医管局收集的82万例不良事件报告中最常见的三项错误，该三项错误占82万例不良事件的53％；还介绍了抽样医院主动报告的五类不良事件，以及国家药品不良事件反应网络监测中心的药品与器械不良事件报告。介绍了北京中卫云医疗数据分析与应用研究院100万例误诊报告的简要内容，简要列举了6个典型误诊病例。介绍了中国政府主要的质量政策以及通过医院评审工作落实政策，改善医院管理的做法，引用《柳叶刀》杂志对中国医疗状况的评价，说明质量政策与医院评审对提升医疗服务安全质量是有效的。同时指出要警惕新发疾病，减少误诊，关注新技术、新材料、新药品应用时可能出现新的不安全事件，以实现高质量发展的目标。