医疗物资集中采购的风险管控

文章提出医疗机构在执行物资集中采购时易出现的问题如:招标方式不清、重要招标程序不规范、招标文件编制不专业等,将严重影响集中采购的权威性和高效率;针对这些风险,作者通过深层次解读相关法律法规,结合实际操作,提出更加规范和可行的解决办法。     

Differentiating between trust and dependence of patients with coronary heart disease: furthering the sociology of trust

Sociological health research on the concept of trust has been bedevilled by its multivocalities. This article extends Luhmann's attempts to clarify a sociology of trust. Luhmann argued a semantic distinction between trust and confidence. In this article, we use empirical data on patient ‘trust’ in doctors to argue that there is also a semantic distinction between trust and dependence. We conducted 37 semi-structured interviews with patients with coronary heart disease in Adelaide, Australia in 2008 and 2009. Our findings indicate that risk, familiarity and time were critical to understand the distinction between trust and dependence. We argue that patients in situations of emergency (heightened risk) ‘depended’ on, rather than trusted, doctors, given the patients lack of familiarity with their doctors. Time was a mediating factor, as the more ‘urgent’ the situation, the more likely it was that dependence came into play, since the situation was ‘unfamiliar’. Rather than juxtaposing trust and dependence, in this article we show how dependence may coexist with trust in the health care system in times of emergency.     

Withdrawal from mental and psychosocial care during pregnancy

Abstract

Psychopathology, psychosocial problems and substance use (PPS) commonly occur in pregnant women, and can have a negative impact on the course of pregnancy and the healthy development of the child. As PPS often remains undetected and untreated during pregnancy, we developed and implemented a four-step screen-and-treat protocol in routine obstetric care, with: (i) screening including triage and subsequent confirmation, (ii) indication assessment, (iii) transfer towards care and (iv) utilization of care. Adherence to the protocol and risk factors associated with dropout were examined for 236 Dutch pregnant women in a deprived urban area. Seventy-nine percent of women accepted the screening, 21% dropped out during triage, 15% during confirmation, 3% during transfer and 8% thereafter. Provided reasons for dropout were lack of time and lack of perceived benefit. In particular, smokers, multiparous women, and women of non-Western ethnicity dropout on the way towards mental and psychosocial care. For a successful implementation of the protocol in the future, with improved adherence of pregnant women to the protocol, education of women on PPS risks, motivational skills and compulsory treatment are worth investigation.     

Risk Factors for Injury in Rural Iowa

SUMMARY

Preliminary analyses of data from one third of the Keokuk County Rural Health Study cohort suggest that risk factors for injury among rural populations are not uniformly distributed and that the pattern varies with the risk factor. For some, such as expo-sure to all-terrain vehicles, the occupation of farmer determines the degree of exposure to the risk factor. Similarly, farmers seem less likely than other rural people to wear their seat belts. Although farm-ers are not more likely than rural nonfarmers to have firearms in their homes, they are more likely to have used them in the last year. How-ever, for other injury risk factors such as alcohol consumption, there do not appear to be differences among farmers, rural nonfarmers, and townspeople. These early results suggest that the Keokuk County Rural Health Study will yield important information for tar-geting specific rural injury prevention interventions.     

Weight-of-evidence evaluation of long-term ozone exposure and cardiovascular effects

We conducted a weight-of-evidence (WoE) analysis to assess whether the current body of research supports a causal relationship between long-term ozone exposure (defined by EPA as at least 30 days in duration) at ambient levels and cardiovascular (CV) effects. We used a novel WoE framework based on the United States Environmental Protection Agency's National Ambient Air Quality Standards causal framework for this analysis. Specifically, we critically evaluated and integrated the relevant epidemiology and experimental animal data and classified a causal determination based on categories proposed by the Institute of Medicine's 2008 report, Improving the Presumptive Disability Decision-making Process for Veterans. We found that the risks of CV effects are largely null across human and experimental animal studies. The few positive associations reported in studies of CV morbidity and mortality are very small in magnitude, mainly reported in single-pollutant models, and likely attributable to bias, chance, or confounding. The few positive effects in experimental animal studies were observed mainly in ex vivo studies at high exposures, and even the in vivo findings are not likely relevant to humans. The available data also do not support a biologically plausible mechanism for the effects of ozone on the CV system. Overall, the current WoE provides no convincing case for a causal relationship between long-term exposure to ambient ozone and adverse effects on the CV system in humans, but the limitations of the available studies preclude definitive conclusions regarding a lack of causation; thus, we categorize the strength of evidence for a causal relationship between long-term exposure to ozone and CV effects as “below equipoise.”     

Sero‐prevalence and epidemiology of peste des petits ruminants in Libya

We conducted a cross‐sectional study during 2013 to quantify the serological prevalence of peste des petits ruminants ( PPR) infection and to investigate host factors associated with PPR infection in small ruminants in Libya. A two‐stage sampling design was carried out. A total number of 148 flocks owning at least 100 heads each were randomly selected. Sixteen to forty‐eight samples were collected from each selected flock. A total number of 3,508 serum samples from unvaccinated animals were collected and analysed at IZSLER Brescia, Italy, by using competitive ELISA, IDvet innovative diagnostics (IDvet 310, France). The overall serological prevalence among SR was 33% (95% CI: 31.4–34.5). Significant differences between the prevalence in the geographical branches were observed. The lowest prevalence level was observed in Zawiyah branch (16.1%), whereas the highest value was obtained for the Sabha branch (56.8%). Considering the age, a serological prevalence of 24.7%, 31.5% and 42.1% was observed in SR <1 year, between 1 and 2 years and more than 2 years, respectively. Statistically significant differences (p  <  .001) in the sero‐prevalence levels were also observed between the age groups. Our findings suggest that the southern part of Libya could be more exposed to the infections coming from the neighbouring countries and this should be better investigated to correctly identify wherever specific entry points can be considered at higher risk than others. The results also confirmed the endemic status of PPR in Libya, with a constant exposure to the infection of the animals during their life. In the framework of the global strategy for control and eradication of PPR, our results, even if obtained by a preliminary study, can contribute to the assessment of the epidemiological situation of PPR in Libya as required by the Stage 1 of the plan.     

Metabolic Surgery: Weight Loss,Diabetes, and Beyond

The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further examines their potential effects on cardiovascular outcomes and mortality and discusses future perspectives.     

A Bayesian Meta-analysis Method for Estimating Risk Difference of Rare Events

Bayesian meta-analysis has been more frequently utilized for synthesizing safety and efficacy information to support landmark decision-making due to its flexibility of incorporating prior information and availability of computing software. However, when the outcome is binary and the events are rare, where event counts can be zero, conventional meta-analysis methods including Bayesian methods may not work well. Several methods have been proposed to tackle this issue but the prior knowledge of event rate was not utilized to increase precision of risk difference estimates. To better estimate risk differences, we propose a new Bayesian method, Beta prior BInomial model for Risk Differences (B-BIRD), which takes into account the prior information of rare events. B-BIRD is illustrated using a real data set of 48 clinical trials about a type 2 diabetes drug. In simulation studies, it performs well in low event rate settings.