《感受nurse的爱抚》之七《约翰与格雷格》

1978年,我由一个有着多年高危护理经验的护士变成了一个心脏病康复科的护士,也正是在那一年,我护理了一对特别的夫妇,他们给我留下了极为深刻的印象,我记忆中的他们始终栩栩如生。他们教会了我爱、勇气和精神上的慷慨。 在第一次去约翰的病床前,我浏览了一下约翰的病历,得知他从52岁时开始出现心脏病发作。我与他一起谈论已经出现的症状,此刻的感受以及他认为该病对他将来生活的影响,我们聊着聊着,就到了探视时间。 就在这时,门外进来一个颇有吸引力的男人,他自我介绍他的名字:格雷格,然后就径直来到床旁坐下。我与约翰接下来又谈了儿分钟,讨论有关出院计划,以及如何改变引起心     

Awareness,Knowledge, and Perceptions of Biosimilars Among Specialty Physicians

Introduction

The Biosimilars Forum conducted a survey through an independent organization from November 20, 2015 to January 4, 2016 in order to assess current levels of awareness, knowledge, and perceptions of biosimilars among US specialty physicians who already prescribe biologics. The survey was intended to provide a baseline level of knowledge about biosimilars and will be repeated in 2–3 years in order to monitor trends over time.

Methods

A 19-question survey was created by the Biosimilars Forum and was administered by an independent third party.

Results

Responses were obtained from 1201 US physicians across specialties that are high prescribers of biologics, including dermatologists, gastroenterologists, hematologist-oncologists, medical oncologists, nephrologists, and rheumatologists.

Conclusions

The results of this survey highlight a significant need for evidence-based education about biosimilars for physicians across specialties. Five major knowledge gaps were identified: defining biologics, biosimilars, and biosimilarity; understanding the approval process and the use of “totality of evidence” to evaluate biosimilars; understanding that the safety and immunogenicity of a biosimilar are comparable to the originator biologic; understanding the rationale for extrapolation of indications; and defining interchangeability and the related rules regarding pharmacy-level substitution. Funding: Biosimilars Forum.

     

Perioperative cardiac evaluation: novel interventions and clinical challenges

Cardiac complications are one of the most important sources of morbidity and mortality after noncardiac surgery. In this review, we discuss the pathophysiology of postoperative cardiac complications and published risk indices and guidelines that allow an estimation of preoperative risk. Recent evidence has challenged the primary role of perioperative beta blockers as a risk reduction strategy. The highest level of evidence for their use is for patients with coronary artery disease or multiple risk factors undergoing vascular surgery. Beta blockers may provide no benefit or may be potentially harmful for low- and intermediate-risk patients and surgeries. For patients with contraindications to beta blockers, diltiazem and clonidine are alternative agents that reduce cardiac risk. Statins are emerging as another potential strategy to reduce cardiac risk, although the evidence is based primarily on retrospective analyses. Coronary artery revascularization does not reduce cardiac complications after noncardiac surgery among patients with stable coronary artery disease.     

Understanding Surge Capacity: Essential Elements

As economic forces have reduced immediately available resources, the need to surge to meet patient care needs that exceed expectations has become an increasing challenge to the health care community. The potential patient care needs projected by pandemic influenza and bioterrorism catapulted medical surge to a critical capability in the list of national priorities, making it front-page news. Proposals to improve surge capacity are abundant; however, surge capacity is poorly defined and there is little evidence-based comprehensive planning. There are no validated measures of effectiveness to assess the efficacy of interventions. Before implementing programs and processes to manage surge capacity, it is imperative to validate assumptions and define the underlying components of surge. The functional components of health care and what is needed to rapidly increase capacity must be identified by all involved. Appropriate resources must be put into place to support planning factors. Using well-grounded scientific principles, the health care community can develop comprehensive programs to prioritize activities and link the necessary resources. Building seamless surge capacity will minimize loss and optimize outcomes regardless of the degree to which patient care needs exceed capability.