Why We Need Continuous Pharmaceutical Manufacturing and How to Make It Happen

We make the case for why continuous pharmaceutical manufacturing is essential, what the barriers are, and how to overcome them. To overcome them, government action is needed in terms of tax incentives or regulatory incentives that affect time.     

The Geriatrician: The Frontline Specialist in the Treatment of COVID-19 Patients

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients.This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.     

Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine

BackgroundAs the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers’ and infant caregivers’ attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia.MethodsWe conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4 months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4 month immunization visit were surveyed.FindingsPrior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed.ConclusionHealthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.     

开展电话回访搭建医患沟通桥梁

通过对3 500余人次的有效电话回访,实施健康教育、健康指导3000余人次,受理健康咨询500余人次,协调和化解各类医疗纠纷20余起。电话回访搭起了和谐医患关系的桥梁。     

影响注意缺陷多动障碍患儿就诊因素的分析

目的分析探讨影响注意缺陷多动障碍（ADHD）患儿延迟就诊的因素。方法采用家庭环境量表（FES-CV）及自编简明就诊因素问卷对68例ADHD患儿的家长进行调查评定，分析影响延迟就诊的相关因素。结果61例患儿完成调查。所有因素经多元线性逐步回归分析，3个自变量差异具有统计学意义，分别为分型（Beta值：-0．449），接触知识（Beta值：0．369），父亲文化（Beta值：-0．268）。结论影响患儿就诊时间延迟的因素有3种情况，其顺序如下：（1）ADHD的注意缺陷型；（2）家长缺乏儿童心理卫重知识；（3）父亲的文化程度低。     

Systems biology: integrating technology,biology, and computation

The Human Genome Project has changed the worlds of biology and medicine-helping to catalyze two major paradigm changes: systems biology and predictive, preventive and personalized medicine. These two themes will dominate 21st century biology and medicine. I will discuss these changes and indicate how they may interface with with the process of aging.     

Reported Challenges in Health Technology Assessment of Complex Health Technologies

ObjectivesWith complex health technologies entering the market, methods for health technology assessment (HTA) may require changes. This study aimed to identify challenges in HTA of complex health technologies.MethodsA survey was sent to European HTA organizations participating in European Network for HTA (EUnetHTA). The survey contained open questions and used predefined potentially complex health technologies and 7 case studies to identify types of complex health technologies and challenges faced during HTA. The survey was validated, tested for reliability by an expert panel, and pilot tested before dissemination.ResultsA total of 22 HTA organizations completed the survey (67%). Advanced therapeutic medicinal products (ATMPs) and histology-independent therapies were considered most challenging based on the predefined complex health technologies and case studies. For the case studies, more than half of the reported challenges were “methodological,” equal in relative effectiveness assessments as in cost-effectiveness assessments. Through the open questions, we found that most of these challenges actually rooted in data unavailability. Data were reported as “absent,” “insufficient,” “immature,” or “low quality” by 18 of 20 organizations (90%), in particular data on quality of life. Policy and organizational challenges and challenges because of societal or political pressure were reported by 8 (40%) and 4 organizations (20%), respectively. Modeling issues were reported least often (n = 2, 4%).ConclusionsMost challenges in HTA of complex health technologies root in data insufficiencies rather than in the complexity of health technologies itself. As the number of complex technologies grows, the urgency for new methods and policies to guide HTA decision making increases.     

急性非静脉曲张性上消化道出血治疗的护理

目的研究分析急性非静脉曲张性上消化道出血治疗的护理效果。方法选择我院于2019年3月—2020年12月内收治的360例急性非静脉曲张性上消化道出血患者,将所有患者按照随机数表方法,分为对照组(180例,进行基础性护理干预)和观察组(180例,进行细节性护理干预)。对两组患者在护理完成后的效果进行收集和分析。结果对照组患者在采取常规护理方法干预后,其消化道功能恢复时间与住院时间分别为(6.84±1.24)d、(9.26±2.18)d;观察组患者在采取个性化护理方式干预后,消化道功能恢复时间与住院时间分别为(4.48±0.87)d、(6.05±1.24)d。两组相比较,观察组住院时间较短、消化道功能恢复较快,差异具有统计学意义(P<0.05)。结论在胃镜下治疗急性非静脉曲张性上消化道出血患者给予细节性护理干预能够提高手术效果,减少住院时间,加快病情恢复。     

Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital

ObjectivesThe purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals.DesignA prospective multicenter observational study.Setting and ParticipantsOur series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project.MethodsAfter signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell’s C-index and categorical Net Reclassification Index (NRI).ResultsFunctional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65–0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53–0.56), and Charlson score (C-index 0.58, 95% CI 0.56–0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14–0.31) or Charlson score (NRI 0.13, 95% CI 0.03–0.20) to functional cluster model slightly improved the accuracy of prediction.Conclusions and ImplicationsFunctional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals’ needs and to design tailored preventive interventions.