A Comparison Between Recipients Receiving Matched Kidney and Those Receiving Mismatched Kidney from the Same Cadaver Donor

The optimal allocation of cadaveric kidneys for transplantation with reference to human leukocyte antigen (HLA) match and sharing these organs to a distant center remains controversial. The current analysis was performed using the United Network for Organ Sharing (UNOS) database for cadaveric kidney transplants (Tx) between 1988 and 1997. The graft survivals of zero-mismatch (matched) kidneys with the mate (mismatched) kidneys were compared. There were 2385 donors and 4770 Tx. Significant differences in recipient demographics between matched and mismatched Tx were: fewer African-American race (AA) in the matched group (9.0% vs. 21.9%), higher number of previous Tx (25.5% vs. 14.8%) and elevated mean cold ischemia time (24.0 vs. 22.2 h). Post-Tx dialysis requirements were similar (22.8% vs. 24.1%, p = 0.62) and matched kidneys had to travel more distance (920 vs. 232 miles). Using a Cox model, the matched group had a decreased relative hazard of graft failure of 23.0% (p = 0.0002) or 35% (p < 0.0001) with and without censoring for death. There was significantly better graft survival in the matched recipients in all pairs except AA (matched) and non-AA (mismatched). For older donors (> or = 50 years, n = 1508), the matched grafts survival was marginally significant (p =0.05). Matched kidneys have improved survival compared with the mismatched kidneys despite the longer distance traveled. The benefit of mismatched transplants was predominantly seen in non-AA.     

Score Statistic to Test for Genetic Correlation for Proband-Family Design

In genetic epidemiological studies informative families are often oversampled to increase the power of a study. For a proband‐family design, where relatives of probands are sampled, we derive the score statistic to test for clustering of binary and quantitative traits within families due to genetic factors. The derived score statistic is robust to ascertainment scheme. We considered correlation due to unspecified genetic effects and/or due to sharing alleles identical by descent (IBD) at observed marker locations in a candidate region. A simulation study was carried out to study the distribution of the statistic under the null hypothesis in small data‐sets. To illustrate the score statistic, data from 33 families with type 2 diabetes mellitus (DM2) were analyzed. In addition to the binary outcome DM2 we also analyzed the quantitative outcome, body mass index (BMI). For both traits familial aggregation was highly significant. For DM2, also including IBD sharing at marker D3S3681 as a cause of correlation gave an even more significant result, which suggests the presence of a trait gene linked to this marker. We conclude that for the proband‐family design the score statistic is a powerful and robust tool for detecting clustering of outcomes.     

How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.     

Egg-sharing in assisted conception: ethical and practical considerations

The present acute shortage of eggs for donation cannot be overcomeunless adequate guidelines are set to alleviate the anxietiesregarding payments, in cash or kind, to donors. The currentHuman Fertilisation and Embryology Authority (HFEA) guidelinesdo not allow direct payment to donors but accept the provisionof lower cost or free in-vitro fertilization (IVF) treatmentto women in recognition of oocyte donation to anonymous recipients.Egg-sharing achieved in this way enables two infertile couplesto benefit from a single surgical procedure. However, the practicalguidelines related to this approach are ill-defined at the presenttime leading to some justifiable uncertainty. A pilot studywas therefore undertaken in order to establish the place ofegg-sharing in an assisted conception programme. The currentHFEA guidelines on medical screening of patients, counselling,age and rigid anonymity between the donor and recipient werefollowed. The study involved 55 women (25 donors and 30 recipients)in 73 treatment cycles involving fresh and frozen-thawed embryos.Donors were previous IVF patients who, regardless of their abilityto pay, shared their eggs equally with matched anonymous recipients.They paid only for their consultations and tests right up tothe point of being matched with a recipient The sole recipientpaid the cost applicable in egg donation of a single egg collection,although both received embryo transfers. The results indicatethat although the recipients were older than the donors (41.4± 0.9 versus 31.6 ± 0.5 years), and there wasno difference in the mean number of eggs allocated, the percentagefertilization rates, or the mean number of embryos transferred,there were more births per patient amongst recipients than amongstdonors (30 versus 20%). We conclude that providing the donorsare selected carefully, this scheme whereby a sub-fertile donorhelps a sub-fertile recipient is a very constructive way ofsolving the problem of the shortage of eggs for donation. Thereare also the advantages of including a group of women who wouldotherwise be denied treatment Problems related to ‘patientcoercion’ can, in our view, be fully overcome by the applicationof strict common-sense safeguards. The ideal of pure altruismis not without its medical and moral risk. The success of egg-sharingdepends on shared interests and a degree of altruism betweenthe donor, the recipient and the centre. The current HFEA guidelinesshould be applauded for enabling a highly effective conceptof mutual help to develop.     

学术期刊关联数据出版与共享中的信息安全管理

【目的】 对我国学术期刊关联数据出版与共享中的信息安全管理的概念、政策及其存在的问题进行梳理,有助于科学数据出版与共享工作的推进。【方法】 基于我国科学数据出版与共享的演化过程,以及地理资源期刊在科学数据共享方面的现状与发展情况,对期刊论文关联数据出版和安全管理情况进行分析,对平台间合作的模式进行探讨。【结果】 为实现科学数据的价值最大化,中国自上而下建立起了科学数据共享系统,包括网络基础设施、数据库、数据中心、数据服务平台等,制定了一系列数据获取和管理规范,并制定了保障科学数据信息安全的相关法律。【结论】 科学数据出版与共享应建立在安全的基础上。经过初期的大规模建设后,数据出版与共享及其安全管理应走向“提质增效”阶段,要注重高新技术的注入和专业人才的培养。在管理措施上要以保证数据安全为基础,以数据质量为核心,从而提升信息安全管理水平,提高数据再应用效率。     

基于共享理念的急诊CTA应急平台构建与效果评价

目的基于共享理念的急诊CTA应急平台构建与效果评价。方法选取2019年1—9月急诊CTA检查患者为对照组,2019年11月—2020年8月急诊CTA检查患者为观察组。对照组采用常规急诊值班制,观察组建立急诊CTA应急平台。对申请检查科室、检查项目进行描述性统计,比较两组CTA检查时间及入院患者预后转归情况。结果申请科室以急诊内科为主,检查项目以头颅、胸腹部为主,急诊CTA检查时间对照组中位数为46 min,观察组中位数为20 min,两组对比差异有统计学意义(P<0.05),对照组37例患者中有8例(21.7%)致残,观察组103例患者中有8例(7.8%)致残,两组对比差异有统计学意义(P<0.05)。结论组建急诊CTA应急平台能缩短急诊CTA影像学检查时间,降低致残率,提高患者生活质量,优化护理人力资源,值得临床推广。     

儿童医院下呼吸道感染经济损失的病例对照研究

目的　了解儿科住院患儿发生医院下呼吸道感染所造成的直接经济损失。方法　采用 1∶1病例对照研究的方法 ,调查 1 0 1对住院患儿的医疗费用 ,计算医院感染的直接经济损失。结果　病例组的平均医疗费用为3430 .5 3元 ,对照组为 2 1 34.0 5元 ,两组比较 ,差异有显著性 (P <0 .0 5 )。中西药费占总增加费用的 4 3.0 3% ;治疗费、化验费和床位费分别占总增加费用的 2 8.1 7% ,9.31 % ,5 .79%。心血管内科医院感染病例医疗费用最高 ,平均每例增加 4 2 36 .93元 ;新生儿内科次之 ,平均每例增加 1 736 .93元。感染患者的平均住院天数为 1 3.0 9d ,比对照组的 8.1 6d高 (P <0 .0 5 )。结论　医院感染的发生增加了患儿的医疗费用 ,延长了住院日 ,降低了病床周转率 ;认真做好医院感染监控工作可获得经济效益和社会效益     

德国柏林Pflgewerk养老机构学习见闻分享

2019年9—12月,笔者参与了苏州大学与德国柏林Pflgewerk养老机构针对失能老年人居家照护课程研发与智慧化养老的交流项目,在学习与交流期间,德国完善的居家照护体系,先进适老辅具的研发与运用,系统规范的照护员培训课程,浓厚的人文关怀气氛与多学科团队合作的安宁疗护中心令笔者印象深刻。本文结合学习交流活动的亲身经历,...     

新型冠状病毒肺炎疫情期间临床试验工作现状的调查与研究

新型冠状病毒肺炎疫情蔓延下,临床试验工作的节奏遭受巨大挑战,南京大学医学院附属鼓楼医院基于疫情期间临床试验工作指引和相关法规,通过设计调查问卷,调研临床试验工作开展现状并进行分析,对在研项目的研究者、临床监查员(clinical research associate,CRA)、研究协调员(clinical resear...     

澳大利亚医疗资源互补共享合作模式对我国推行双向转诊工作的启示

本文借鉴澳大利亚的医疗资源互补共享合作模式，结合中国国情和上海市卫生系统的现状，提出在我国如何通过双向转诊制度达到互补，在卫生信息收集方面通过联系员制度实现共享。