我国伦理委员会管理制度调研与结果分析

从各国的监管经验来看,伦理委员会在临床试验管理中发挥着重要的作用。为理清我国伦理委员会管理制度的现状及存在的问题,在前期文献研究的基础上,通过问卷调研和专家访谈,对伦理委员会的监管问题、影响伦理审查的“质量”因素、影响伦理审查的“效率”因素等关键问题进行了调研。调研结果表明,多数调研对象认为应不断完善我国的伦理委员会管理制度,进一步提高伦理审查的质量和效率。     

基因编辑与遗传代谢性疾病

随着新生儿遗传代谢病筛查和二代基因测序技术的逐渐普及,越来越多的遗传代谢病在早期得到诊断.大多遗传代谢病治疗手段非常有限,基因治疗通过外源DNA序列导入,可能使遗传代谢病从基因水平彻底根治.各种基因编辑技术在遗传代谢病领域的应用均具有其优势与不足.在基因编辑技术的临床应用中需严格遵循相关的伦理制度.     

试论中医蒙医通用药材比较研究

本文从中医药学和蒙医药学具有较多的通用药材为切入点,从传统医药理论、药物临床应用等方面比较研究,探讨异同之处。本文有助于拓展天然药物临床应用、探索天然药物的药性物质基础,进而开发针对现代疾病谱疗效确切的天然药物新药。     

Make it or break it: On-time vaccination intent at the time of Covid-19

On-time effective vaccination is critical to curbing a pandemic, but this is often hampered by citizens' hesitancy to get quickly vaccinated. This research concentrates on the hypothesis that, besides traditional factors in the literature, vaccination success would hinge on two dimensions: a) addressing a broader set of risk perception factors than health-related issues only, and b) securing sufficient social and institutional trust at the time of vaccination campaign launch. We test this hypothesis regarding Covid-19 vaccination preferences in six European countries and at the early stage of the pandemic by April 2020. We find that addressing the two roadblock dimensions could further boost Covid-19 vaccination coverage by 22%. The study also offers three extra innovations. The first is that the traditional segmentation logic between vaccine “acceptors”, “hesitants” and “refusers” is further justified by the fact that segments have different attitudes: refusers care less about health issues than they are worried about family tensions and finance (dimension 1 of our hypothesis). In contrast, hesitants are the battlefield for more transparency by media and government actions (dimension 2 of our hypothesis). The second added value is that we extend our hypothesis testing with a supervised non-parametric machine learning technique (Random Forests). Again, consistent with our hypothesis, this method picks up higher-order interaction between risk and trust variables that strongly predict on-time vaccination intent. We finally explicitly adjust survey responses to account for possible reporting bias. Among others, vaccine-reluctant citizens may under-report their limited will to get vaccinated.     

Parathyroidectomy and Cinacalcet Use in Medicare-Insured Kidney Transplant Recipients

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Association between Covid-19 surge and emergency department patient flow and experience

BackgroundPreparations for Covid-19 in the Netherlands included hospital reconfigurations to increase capacity for the expected surge at the emergency department (ED). We describe patients’ ED length of stay (LOS), crowding and experiences of patients with respiratory complaints during the first Covid-19 peak.MethodsRetrospective analysis of demand, ED LOS, crowding, and a patient experience survey during a 12-week period in 2020 and similar periods in 2018 and 2019. Crowding levels were calculated using the National ED OverCrowding Scale.ResultsThe number of patients with respiratory complaints increased significantly, while total ED numbers were unchanged. Although presentation during the Covid-19 peak and needing hospital admission were associated with a longer ED LOS in patients with respiratory complaints, significantly less crowding occurred compared with the 2018 and 2019 periods. Increased ED LOS was associated with lower patient experience scores.ConclusionAdvanced warning and its associated preparation within the hospital and the community prevented significant delays in ED throughput during the first Covid-19 peak.     

Norwegian nurses' perceptions of assisted dying requests from terminally ill patients—A qualitative interview study

This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses.