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1.
ObjectivesSeveral implementation strategies can reduce potentially inappropriate medication (PIM) prescribing. Although use of PIMs has declined in recent years, it remains prevalent. Various strategies exist to improve the appropriateness of medication use. However, little is known about the processes of these different implementation strategies. This scoping review aims to investigate how the process evaluation of implementation strategies for reducing PIM prescribing in the older population has been studied.MethodsWe searched for process evaluations of implementation strategies for reducing PIM prescribing in PUBMED, SCOPUS and Web of Science published between January 2000 and November 2019 in English. We applied the following inclusion criteria: patients aged ≥65 years, validated PIM criteria, and implementation process evaluated. The review focuses on decision support for health care professionals. We described the findings of the process evaluations, and compared the authors’ concepts of process evaluation of the included publications to those of Proctor et al.( 2010).ResultOf 9131 publications screened, 29 met our inclusion criteria. Different process evaluation conceptualizations were identified. Most process evaluations took place in the initial stages of the process (acceptability, adoption, appropriateness, and feasibility) and sustainability and implementation costs were seldom evaluated. None of the included publications evaluated fidelity.Multifaceted interventions were the most studied implementation strategies. Medication review was more common in acceptability evaluations, multidisciplinary interventions in adoption evaluations, and computerized systems and educational interventions in feasibility evaluations. Process evaluations were studied from the health care professionals’ viewpoint in most of the included publications, but the management viewpoint was missing.DiscussionThe conceptualization of process evaluation in the field of PIM prescribing is indeterminate. There is also a current gap in the knowledge of sustainability and implementation costs. Clarifying the conceptualization of implementation process evaluation is essential in order to effectively translate research knowledge into practice.  相似文献   
2.
目的 探讨“一键启动”流程优化在缩短急性缺血性脑卒中患者静脉溶栓时间中的应用效果。方法 选择2020年1-12月笔者所在医院收治的急性缺血性脑卒中静脉溶栓患者86例为研究对象,其中2020年1-6月入院进行静脉溶栓的41例为对照组,2020年7-12月入院进行静脉溶栓的45例为观察组。对照组采用常规抢救流程,观察组采用“一键启动”流程优化进行干预。比较2组入院至见到神经内科医生的时间(door to physician,DTP)、入院至实验室检查出报告时间(door to laboratory,DTL)、入院至溶栓用药时间(door to needle time,DNT)、入院至完成CT检查的时间(door to imaging,DTI)、美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分与改良 RANKIN量表(modified Rankin scale, MRS)评分。结果 观察组 DTP、DTL、DTI、DNT均明显短于对照组(Z=-8.506,P<0.001; Z=-6.750,P<0.001; Z=-5.812,P<0.001; Z=-6.026,P<0001)。观察组患者溶栓后24 h、出院时NIHSS评分及出院时MRS评分均低于照组(Z=-2.689,P=0.007; Z=-2.354,P=0.019; Z=-2.255,P=0.024)。结论 “一键启动”优化了缺血性脑卒中患者的救治流程,减少了院内延误时间,改善了患者的预后,临床应用价值明显,值得推广。  相似文献   
3.
《Indian heart journal》2022,74(5):351-356
AimsIMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients.Methods/Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant.A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001).ConclusionsA process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.  相似文献   
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5.
To minimize the gastric and esophageal injury effect, a system to deliver doxycycline hyclate (DOXY) to the duodenum area is needed. DOXY-containing modified-release oral pellets (DMOP) coated with hydroxypropyl methylcellulose phthalate HP-55 (HPMCP HP-55) and hydroxypropyl methylcellulose E15 (HPMC E15) appear to be a reasonable choice. This coating layer dissolves at pH 5.5, which is the pH of the duodenum, but not at a gastric pH (1.2). The formulation and preparation of DMOP were optimized, and a scale-up test was performed. The results showed that the production reproducibility was acceptable, and the quality of DMOP well met the standards of Chinese Pharmacopeia (Ch.P, 2015 edition). Notably, the accumulated DOXY release was lower than 50% at pH 1.2 (20 min) and higher than 85% at pH 5.5, which met the USP40-NF35 standard for DOXY modified-release formulations. Moreover, the storage stability of DMOP with different packages was investigated by stress testing, accelerated and long-term testings. The stability of DMOP was maintained up to 12 months, in terms of DOXY content and in vitro release behavior. The results seem to suggest that DMOP could be a promising duodenum delivery system.  相似文献   
6.
The Editors’ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.  相似文献   
7.
《Vaccine》2019,37(47):7003-7010
Control and prevention of rapid influenza spread among humans depend on the availability of efficient and safe seasonal and pandemic vaccines, made primarily from inactivated influenza virus particles. Current influenza virus production processes rely heavily on embryonated chicken eggs or on cell culture as substrate for virus propagation. Today’s efforts towards process intensification in animal cell culture could innovate viral vaccine manufacturing using high-yield suspension cells in high cell density perfusion processes. In this work, we present a MDCK cell line adapted to grow as single cell suspension with a doubling time of less than 20 h, achieving cell concentrations over 1 × 107 cells/mL in batch mode. Influenza A virus titer obtained in batch infections were 3.6 log10(HAU/100 µL) for total- and 109 virions/mL for infectious virus particles (TCID50), respectively. In semi-perfusion mode concentrations up to 6 × 107 cells/mL, accumulated virus titer of 4.5 log10(HAU/100 µL) and infectious titer of almost 1010 virions/mL (TCID50) were possible. This exceeds results reported previously for cell culture-based influenza virus propagation by far and suggests perfusion cultures as the preferred method in viral vaccine manufacturing.  相似文献   
8.
头孢克肟的粒度分布、结晶度及杂质含量是影响其加工性能、颜色 ( 白度 )、贮存时间和生物毒性的关键质量指标, 在实际生产过程中发现这些关键指标较难控制。本研究应用了先进在线过程分析技术对头孢克肟的反应结晶过程进行了测量和 分析,包括:傅里叶变换衰减全反射红外光谱仪 (ATR-FTIR) 准确测量结晶过程浓度,并辅助解释反应结晶过程转晶机理,在 线成像系统测量结晶过程颗粒的形貌和粒形变化,在线浊度仪测量成核时刻。实验考察了反应结晶过程的反应温度、养晶时刻、 养晶时间、加料速率、搅拌速率等工艺条件对头孢克肟粒度分布、白度、结晶度和杂质含量的影响,探寻反应结晶过程晶型转 变的规律。结果表明,头孢克肟结晶为聚结生长方式,养晶时刻是影响其聚集体粒度分布及白度的关键因素,养晶时间与滴酸 速率是影响结晶度的关键因素。实验优化得到了头孢克肟反应结晶的最佳操作工艺并可为其工业化提供重要参考,利用该工艺 得到了粒度分布均匀、结晶度高、杂质含量低和白度好的产品。  相似文献   
9.
目的:建立加味玉屏风浓煎剂4种活性成分HPLC检测方法,对加味玉屏风浓煎剂进行工艺优化。方法:采用正交试验L9(34)法,优化加水量、浸泡时间、煎煮时间;选用加味玉屏风浓煎剂浸出物含量及毛蕊异黄酮葡萄糖苷、升麻素苷、5-O-甲基维斯阿米醇苷和肉桂酸4种成分含量为指标对制作工艺进行考察。结果:加味玉屏风浓煎剂最佳工艺为浸泡60 min,煎煮210 min,加入10倍量水。结论:通过对加味玉屏风浓煎剂的工艺研究,得到了优化的制备工艺。  相似文献   
10.
背景 操作技能直接观察评估(DOPS)是评估者通过直接观察学生技能操作的过程即时给予评估和反馈,是一种具有教学功能的形成性评价工具,能够客观、全面地评估学生的学习过程。将DOPS引入全科医学专业教学评价具有重要意义。目的 探讨在全科医学科毕业实习中应用DOPS进行形成性评价的意义和效果。方法 于2018年9-10月,采用整群抽样方法选择中国医科大学2013级七年制临床医学专业学生72例为研究对象。采用随机数字表法将72例学生随机分为试验组和对照组,每组36例。试验组和对照组学生均安排在中国医科大学附属第一医院全科医学科病房参加为期1周的实习;实习结束后,进行为期1周的临床实践。对照组的临床实践操作技能培训采用传统带教方法,试验组在1周的临床实践过程中开展2次DOPS形成性评价,两组由相同教师授课。轮转结束时,应用小型临床评价演练(Mini-CEX)、临床技能操作评分、理论考试及问卷调查法进行教学评价。结果 试验组学生的理论考试成绩与对照组比较,差异无统计学意义(P>0.05)。试验组和对照组学生的临床技能操作得分分别为(76.67±6.20)、(72.50±7.66)分,组间差异有统计学意义(P<0.05)。两组Mini-CEX成绩比较:试验组学生体格检查、人文关怀、沟通技巧、整体表现得分高于对照组,差异有统计学意义(P<0.05)。DOPS临床操作时间为(11.32±1.76)min,反馈时间为(13.14±2.21)min,合计时间为(24.46±1.97)min。>80%的学生认为DOPS有利于发现自身操作中的小问题、有助于感受到教师的重视和关怀、可行性强、可以提高操作技能、培养人文素养和交流沟通能力。结论 在全科医学科毕业实习中开展DOPS作为形成性评价可以有效提高学生临床技能操作和Mini-CEX成绩,改善教学效果。  相似文献   
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