医院应急医用物资管理实践与效果分析

医院作为应对突发公共卫生事件的主战场,应急医用物资保障能力至关重要。针对突发公共卫生事件中应急医用物资需求复杂、时间紧迫、专业性强等特点,从应急医用物资的产品目录、需求预判、灵活储备、动态调整和供应商考核评分机制等方面,构建了医院应急医用物资管理流程,提升了医院应对突发公共卫生事件的综合管理能力。     

The superspreading places of COVID-19 and the associated built-environment and socio-demographic features: A study using a spatial network framework and individual-level activity data

Previous studies observed that most COVID-19 infections were transmitted by a few individuals at a few high-risk places (e.g., bars or social gathering venues). These individuals, often called superspreaders, transmit the virus to an unexpectedly large number of people. Further, a small number of superspreading places (SSPs) where this occurred account for a large number of COVID-19 transmissions. In this study, we propose a spatial network framework for identifying the SSPs that disproportionately spread COVID-19. Using individual-level activity data of the confirmed cases in Hong Kong, we first identify the high-risk places in the first four COVID-19 waves using the space-time kernel density method (STKDE). Then, we identify the SSPs among these high-risk places by constructing spatial networks that integrate the flow intensity of the confirmed cases. We also examine what built-environment and socio-demographic features would make a high-risk place to more likely become an SSP in different waves of COVID-19 by using regression models. The results indicate that some places had very high transmission risk and suffered from repeated COVID-19 outbreaks over the four waves, and some of these high-risk places were SSPs where most (about 80%) of the COVID-19 transmission occurred due to their intense spatial interactions with other places. Further, we find that high-risk places with dense urban renewal buildings and high median monthly household rent-to-income ratio have higher odds of being SSPs. The results also imply that the associations between built-environment and socio-demographic features with the high-risk places and SSPs are dynamic over time. The implications for better policymaking during the COVID-19 pandemic are discussed.     

Characterizing Emergency Department Use in Assisted Living

ObjectivesLittle is known about emergency department (ED) utilization among the nearly 1 million older adults residing in assisted living (AL) settings. Unlike federally regulated nursing homes, states create and enforce AL regulations with great variability, which may affect the quality of care provided. The objective of this study was to examine state variability in all-cause and injury-related ED use among residents in AL.DesignObservational retrospective cohort study.Setting and ParticipantsWe identified a cohort of 293,336 traditional Medicare beneficiaries residing in larger AL communities (25+ beds).MethodsWith Medicare enrollment and claims data, we identified ED visits and classified those because of injury. We present rates of all-cause and injury-related ED use per 100 person-years in AL, by state, adjusting for age, sex, race, dual-eligibility, and chronic conditions.ResultsRisk-adjusted state rates of all-cause ED visits ranged from 100.9 visits/100 AL person-years [95% confidence interval (CI) 92.8, 109.9] in New Mexico to 162.3 visits/100 AL person-years (95% CI 154.0, 174.7) in Rhode Island. The risk-adjusted rate of injury-related ED visits ranged from 18.7 visits/100 AL person-years (95% CI 17.2, 20.3) in New Mexico to 35.7 visits/100 AL person-years (95% CI 34.7, 36.8) in North Carolina.Conclusions and ImplicationsWe observed significant variability among states in all-cause and injury-related ED use among AL residents. There is an urgent need to better understand why this variability is occurring to prevent avoidable visits to the ED.     

Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis

ObjectivesTo systematically review and synthesize the evidence on differential associations between antihypertensive medication (AHM) classes and the risk of incident dementia.DesignSystematic review and random effects frequentist network meta-analysis. Embase, MEDLINE, and the Cochrane library were searched from origin to December 2019.Setting and participantsRandomized controlled trials (RCTs) and prospective cohort studies that compared associations of different AHM classes with incident all-cause dementia and/or Alzheimer's disease over at least 1 year of follow-up.MeasuresAll cause dementia and/or Alzheimer's disease.ResultsFifteen observational studies and 7 RCTs were included. Data on AHM classes were available for 649,790 participants and dementia occurred in 19,600 (3.02%). Network meta-analysis showed that in observational studies, treatment with either calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs) was associated with lower dementia risks than treatment with other antihypertensives: CCBs vs angiotensin converting enzyme inhibitors (ACE inhibitors) (HR=0.84, 95% CI 0.74-0.95), beta blockers (HR=0.83, 95% CI 0.73-0.95) and diuretics (HR=0.89, 95% CI 0.78-1.01) and ARBs vs ACE inhibitors (HR=0.88, 95% CI 0.81-0.97), beta blockers (HR=0.87, 95% CI 0.77-0.99), and diuretics (HR=0.93, 95% CI 0.83-1.05). There were insufficient RCTs to create a robust network based on randomized data alone.Conclusions and ImplicationsRecommending CCBs or ARBs as preferred first-line antihypertensive treatment may significantly reduce the risk of dementia. If corroborated in a randomized setting, these findings reflect a low-cost and scalable opportunity to reduce dementia incidence worldwide.     

大学生男男性行为者社会网络特征与多性伴的相关性研究

目的 了解长沙市大学生男男性行为人群(men who have sex with men, MSM)的社会网络特征与多性伴之间的相关性,为制定更有针对性的艾滋病防治措施提供科学依据。 方法 运用横断面研究设计,于2017年9月—2018年3月,在长沙市通过连续样本抽样及滚雪球抽样法招募大学生MSM,并进行匿名问卷调查。 结果 有效调查214人,共提名800名社交网络成员和430名性网络成员。多性伴MSM占47.6%。社交网络大小、社交网络密度的中位数和四分位数分别为6(3.75, 6)、0.1(0, 0.5)。性网络大小的中位数和四分位数为2(2,3),性网络密度为0。经多因素logistic回归分析发现,做过HIV检测(OR=2.688, 95%CI:1.336~5.407)、有偶然性伴 (OR=2.409, 95%CI=1.619~3.583)、社交网络大于5人(OR=2.163, 95%CI=1.093~4.280)、性网络与社交网络重合程度高者(OR=0.624, 95%CI=0.412~0.945),有2个或以上性伴的可能性大。 结论 大学生MSM多性伴行为普遍,且与部分社会网络特征相关,建议通过同伴进行社会网络干预,预防大学生MSM群体中HIV传播。     

医疗器械供应链弹性管理的实践探讨

通过建立健全医院层面应急管理体系,建立医疗器械供应链预警机制,进行医院内外部动态管理,以信息化提高供应链可视性,可实现医疗器械供应链弹性管理。该管理模式能够有效确保供应链稳定性和可恢复性,进而提升医院应急防控能力,最终保障患者和医务人员安全。     

COVID-19对学术交流的影响及学术出版机构的应对举措

【目的】 研究COVID-19疫情暴发给学术交流及学术出版带来的深远影响。【方法】 利用文献调研法和案例分析法挖掘COVID-19疫情带来的学术环境变化,并探讨学术出版的整体变化趋势和国内外出版机构的应对方式。【结果】 COVID-19疫情改变了当前的学术交流环境:加速推进开放科学进程,快速传播的预出版模式受到青睐,开放评审促进快速学术交流,多项基金项目助力COVID-19科学研究,中国科研人员应对COVID-19反应积极而迅速。出版机构顺应学术出版的整体趋势,为科学共同体提供大量免费服务,扩大知识服务的目标群体,提供海量知识及COVID-19快速发表通道,我国出版机构应对COVID-19也采取了大量积极举措。【结论】 国内外出版机构应对突发事件时应建立学术出版应急机制,增强知识服务能力,促进知识创新及传播,以适应一个全新的快速发展的学术环境。     

纳洛酮抢救海洛因中毒618例临床分析

目的：观察纳洛酮抢救海洛因中毒的疗效。方法：对618例海洛因中毒患,用纳洛酮抢救,首次剂量给纳洛酮针剂0．4－0．8mg静注,然后以0．4mg每5min1次,直到患清醒后再给0．8－1．2mg维持静滴。结果：618例中死亡9例,抢救成功率达98％。结论：纳洛酮是抢救海洛因中毒的理想特效药。     

Analysis of pharmacological mechanisms of Yinyanghuo as treatment of erectile dysfunction with network pharmacology-based strategy

Erectile dysfunction is considered an important health problem that impacts the quality of life of men. Yinyanghuo, also called Epimedium or Horny Goat Weed, is a frequently used Chinese traditional herbal medicine, commonly used in treating erectile dysfunction in China. A network pharmacology method was performed systematically, at a molecular level, to analyse the pharmacological mechanism of Yinyanghuo as erectile dysfunction therapy. The network pharmacology method used in this study primarily includes prescreening of the active compounds, prediction of targets, network analysis and gene enrichment analysis. This network analysis proved that 4 targets (AR, NR3C2, PDE5A and BMP2) could be the targets of Yinyanghuo therapy on erectile dysfunction. Besides, gene enrichment analysis predicted that Yinyanghuo might have a role in erectile dysfunction by regulating 10 molecular functions, 8 cellular components, 10 biological processes and 36 possible targets related to 10 signalling pathways. Our study demonstrated the molecular and pharmacological mechanisms of Yinyanghuo against erectile dysfunction with a holistic approach and demonstrated a powerful method for analysing pharmacological mechanisms and rational utilisation of Traditional Chinese Medicine clinically.     

Application of network pharmacology and molecular docking to elucidate the potential mechanism of Astragalus–Scorpion against prostate cancer

The present study aimed to investigate the molecular mechanism of the Astragalus–Scorpion drug pair in the treatment of prostate cancer (PCa). We employed network pharmacology and molecular docking technology to retrieving the active ingredients and corresponding targets of Astragalus–Scorpion by using TCMSP, BATMAN-TCM, TCMID and Swiss Target Prediction Databases. The targets related to PCa were retrieved through GeneCards. Cytoscape software was used to construct the ‘active ingredient–target disease’ network, and GO and KEGG enrichment analyses were performed on the common targets. Autodock software was used for molecular docking verification. In total, 26 active ingredients, 340 potential targets related to active ingredients and 122 common targets were screened from Astragalus–Scorpion drug pair. The core targets of the protein–protein interaction (PPI) network were JUN, AKT1, IL6, MAPK1 and RELA, whereas the core active ingredients were quercetin, kaempferol, formononetin, 7-o-methylisomucronulatol and calycosin. Nearly 762 GO entries and 154 pathways were obtained by using the pathway enrichment analysis. Molecular docking results revealed that quercetin and kaempferol bind to AKT1 and formononetin binds to RELA, all of which were found to be stable bounds.