The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

A modality-specific somatosensory evoked potential test protocol for clinical evaluation: A feasibility study

ObjectiveWe aimed to establish an objective neurophysiological test protocol that can be used to assess the somatosensory nervous system.MethodsIn order to assess most fiber subtypes of the somatosensory nervous system, repetitive stimuli of seven different modalities (touch, vibration, pinprick, cold, contact heat, laser, and warmth) were synchronized with the electroencephalogram (EEG) and applied on the cheek and dorsum of the hand and dorsum of the foot in 21 healthy subjects and three polyneuropathy (PNP) patients. Latencies and amplitudes of the modalities were assessed and compared. Patients received quantitative sensory testing (QST) as reference.ResultsWe found reproducible evoked potentials recordings for touch, vibration, pinprick, contact-heat, and laser stimuli. The recording of warm-evoked potentials was challenging in young healthy subjects and not applicable in patients. Latencies were shortest within Aβ-fiber-mediated signals and longest within C-fibers. The test protocol detected function loss within the Aβ-fiber and Aδ-fiber-range in PNP patients. This function loss corresponded with QST findings.ConclusionIn this pilot study, we developed a neurophysiological test protocol that can specifically assess most of the somatosensory modalities. Despite technical challenges, initial patient data appear promising regarding a possible future clinical application.SignificanceEstablished and custom-made stimulators were combined to assess different fiber subtypes of the somatosensory nervous system using modality-specific evoked potentials.     

中西医结合治疗老年溃疡性结肠炎的研究概况

目的老年溃疡性结肠炎患者逐渐成为溃疡性结肠炎患者中的第二大群体,国内外相关研究逐步展开,发病率的统计、临床特征的总结等方面趋于完善,本研究针对近5年老年溃疡性结肠炎的研究,以中西医结合治疗为出发点,探讨目前老年UC的治疗和研究现况。方法检索PubMed、Cochrane、CNKI等数据库中"老年溃疡性结肠炎(elderly/older-onset UC、UC in elderly patients/population)""中西医结合(Integrated Traditional Chinese Medicine&Western Medicine、Integrated/combined therapy)的随机临床试验,观察性研究、系统评价和/或荟萃分析及所选文章的参考文献、相关研究和评估中的参考文献。结果英文文献检索命中117条,筛选审查后选定27篇(含临床指南)。中文文献命中69条,筛查后选定18篇(含临床指南与专家共识)。所有纳入文献中,临床试验8篇(含2篇protocol),综述及观察性研究31篇。结论近5年国内对于老年UC研究并不多见,治疗方面临床试验以中成药联合西药为主,针对调节炎性因子及凝血功能。国外更多使用草药提取物联合用药治疗UC。     

高频超声对女性肛门括约肌完整性评估的可行性研究

目的 利用高频超声对女性肛门括约肌进行显像与评价,验证高频超声运用于女性肛门括约肌完整性评估的可行性。方法 2020年1月-2021年3月期间行盆底超声检查的110例女性受检者,通过高频线阵探头分别从横断面及矢状面对其肛门括约肌进行连续性扫查,而后两位经验不同的研究人员在互盲情况下独立对肛门括约肌的影像进行完整性评价,记录肛门括约肌损伤情况并进行统计分析。结果 在全部受检者中,高频超声均可从横断面及矢状面清晰地显示各水平肛管特征性的解剖结构,从而当出现异常的超声表现时,可以实现对肛门括约肌损伤的检出。通过Kappa一致性检验可得高频超声对肛门括约肌的完整性评价在不同经验的研究人员间也具有较强的一致性(Kappa=0.888,P<0.05)。结论 高频超声通过对各水平肛管的清晰成像,可以实现对肛门括约肌的完整性评价,为肛门括约肌的评估提供一种新的影像学手段。     

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults

ObjectiveThe Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity.MethodsIn the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants’ baseline characteristics. Professionals completed questions regarding program fidelity.ResultsNo significant differences were found on effect outcomes and adherence between IMP and RCT (all p ≥ 0.135). Intervention effect sizes were equal (0.47–0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations.ConclusionThe effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity.Practice implicationsThe SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.     

不同表面处理方法在纳米混合树脂复合材料修复中的应用

目的： 分析不同表面处理方法和粘接剂自酸蚀功能单体对树脂-复合材料界面即时修复粘结强度和完整性的影响。方法： 采用纳米树脂复合材料制作98个树脂复合材料,随机分为A1、A2、B1、B2、C、D组,各14个试件。表面未处理的试件作为阳性对照组（14个试件）。A1组用Gluma 通用粘接剂系统抛光,A2组用Gluma 通用粘接剂系统抛光、喷砂,B1组用Tokuyama Bond ForceⅡ^TM粘结系统抛光,B2组用Tokuyama Bond ForceⅡ^TM抛光、喷砂,C组仅经抛光样品组。D组仅做喷砂。采用与底物相同的树脂复合材料,对修复后试件进行剪切粘结强度（shear bond strength,SBS）测试,所有样本均进行电子显微镜扫描、测定表面轮廓,进行失效分析。采用SPSS 20.0软件包对数据进行统计学处理。结果： D组修复粘结强度显著高于阴性对照组（P<0.05）,A1、A2、B2、B1组粘结强度显著高于C、D组（P<0.05）;B1、D或A1组相比,粘结强度无显著差异（P>0.05）;B2组、阳性对照组粘结强度无显著差异（P>0.05）。除喷砂、TBFⅡ外,阳性对照组粘合强度值显著高于A1、C组（P<0.05）。抛光后表面粘合失效率高于喷砂样本（P<0.05）;抛光、Gluma处理样品粘合失败率高于抛光、TBFⅡ处理样品（P<0.05）;喷砂、TBFⅡ处理的表面内聚破坏率高于抛光、TBFⅡ处理（P<0.05）。抛光技术的表面粗糙度与喷砂技术相比,较规则且粗糙度较低（P<0.05）。结论： 经喷砂处理的复合材料基材加TBFⅡ,其修复粘结性最强,且表面内聚破坏率较高,TBFⅡ处理粘合失败率低。但经喷砂处理后的材料易堆积食物残渣,而抛光后的材料则不易发生。使用喷砂处理的复合材料基材上加TBFⅡ的患者,需正确有效地维护口腔卫生。     

《医学衷中参西录》张锡纯论治心病理论探析

本文以《医学衷中参西录》为出发点,深入探讨清末民初时期医学大家张锡纯在诊治中医心病方面的重要学术思想,对书中涉及心病理论做一深度挖掘。本书阐明张锡纯先生通过临证辨治构建多种治疗心病的理论框架,从心与神明论诠释心在机体中的重要地位,以君相火论、火不归原论来探讨中医心病临床实践中的重要病机及症状,通过枢机亢进及麻痹论逐个剖析阳明胃腑及三焦、元神及气血、本体阳弱、邪毒惊扰等多方面内外致病因素。张锡纯汇通新旧,衷中参西,对心病辨证施治的独特见解为中医临床诊治心病独树一帜。     

提高病案首页准确性与完整性品管圈应用效果分析

目的探讨品管圈在提高病案首页准确性与完整性的应用效果,为医院管理、医疗安全提供依据。方法选定＂提高病案首页准确性与完整性＂品管圈活动主题,分析原因,制订相应对策,评估实施前后有形效果和无形效果。结果实施后,病案首页基本情况失实漏填、疾病诊断填写欠规范、手术操作填写欠准确的发生率明显低于实施前。团队凝聚力、医务人员责任心、工作积极性、团队合作性、沟通能力、解决问题能力、和谐度等无形成果总评分均明显高于实施前。结论品管圈活动有助于提高病案首页准确性与完整性。