BACKGROUND & AIMS: BACKGROUND:Regulatory bodies including the European Medicines Agency register medications (formulation, route of administration) for specific clinical indications. Once registered, prescription is at clinicians' discretion. Off-label use is beyond the registered use. While off-label prescribing may, at times, be appropriate, efficacy and toxicity data are often lacking. AIM:The aim of this study was to document off-label use policies (including disclosure and consent) in Australian palliative care units and current practices by palliative care clinicians. DESIGN:A national, cross-sectional survey was conducted online following an invitation letter. The survey asked clinicians their most frequent off-label medication/indication dyads and unit policies. Dyads were classified into unregistered, off-label and on-label, and for the latter, whether medications were nationally subsidised. SETTING/PARTICIPANTS:All Australian palliative medicine Fellows and advanced trainees. RESULTS:Overall, 105 clinicians responded (53% response rate). The majority did not have policies on off-label medications, and documented consent rarely. In all, 236 medication/indication dyads for 36 medications were noted: 45 dyads (19%) were for two unregistered medications, 118 dyads (50%) were for 26 off-label medications and 73 dyads (31%) were for 12 on-label medications. CONCLUSIONS:Off-label prescribing with its clinical, legal and ethical implications is common yet poorly recognised by clinicians. A distinction needs to be made between where quality evidence exists but registration has not been updated by the pharmaceutical sponsor and the evidence has not been generated. Further research is required to quantify any iatrogenic harm from off-label prescribing in palliative care.

背景与目标：

BACKGROUND & AIMS: :In this issue of Blood, Yang et al have demonstrated that the therapeutic activity of a targeted therapy, the tyrosine kinase inhibitor (TKI) dasatinib, unexpectedly depends on antitumor T-cell responses that are strongly potentiated by immunostimulation (agonist anti-OX40).

背景与目标： 在本期《血液》中，Yang等人已经证明了靶向治疗，酪氨酸激酶抑制剂 (TKI) 达沙替尼的治疗活性出乎意料地依赖于免疫刺激强烈增强的抗肿瘤T细胞反应 (激动剂anti-OX40)。

BACKGROUND & AIMS: :The present investigation describes the effect on the isolated rat ileum of methanolic extracts derived from Conyza filaginoides (D. C.) Hieron (Asteraceae), Croton fragilis HBK. (Euphorbiaceae), Dodonaea viscosa Jacq. (Sapindaceae), Gymnosperma glutinosum (Spreng) Less. (Asteraceae), Parthenium tomentosum DC. var. stramonium (Greene) Rollins (Asteraceae), Potentilla thurberi A. Gray (Rosaceae), Pterogonum atrorubens (Englem.) H. Gross (Polygonaceae), Zornia venosa Mohlenbr. (Fabaceae) and Datura lanosa Barclay ex Bye (Solanaceae). In all the cases the extracts inhibited, in a concentration-dependent manner, the spontaneous contraction of the intestinal smooth muscle. The most active extract was that of D. viscosa. These findings tend to support the ethnomedical use of the selected species as spasmolytic agents in Mexican traditional medicine. Additionally, the potential antimicrobial activity of the extracts against pathogenic enterobacteria was investigated. Seven of the nine plants evaluated displayed antibacterial effects.

背景与目标： : 本研究描述了源自Conyza filainoides (d.c.) 的甲醇提取物对分离的大鼠回肠的影响Hieron (菊科)，巴豆脆性HBK。(大戟科)，Dodonaea viscosa Jacq。(无患子科)，裸子植物谷草 (spleng) 较少。(菊科)，多叶parthentosum DC。变种stramonium (Greene) Rollins (菊科)，委陵菜thurberi A.灰色 (蔷薇科)，Pterogonum atrorubens (Englem.) H. Gross (蓼科)，Zornia venosa Mohlenbr。(豆科) 和曼陀罗·拉诺萨·巴克莱 (Solanaceae)。在所有情况下，提取物均以浓度依赖性方式抑制肠平滑肌的自发收缩。最具活性的提取物是粘粘D。这些发现倾向于支持所选物种在墨西哥传统医学中作为解痉剂的民族医学用途。此外，还研究了提取物对致病性肠杆菌的潜在抗菌活性。评估的9种植物中有7种具有抗菌作用。

BACKGROUND & AIMS: :The prevalence of renal diseases is rising and reaching 5-15% of the adult population. Renal damage is associated with disturbances of body homeostasis and the loss of equilibrium between exogenous and endogenous elements including drugs and metabolites. Studies indicate that renal diseases are influenced not only by environmental but also by genetic factors. In some cases the disease is caused by mutation in a single gene and at that time severity depends on the presence of one or two mutated alleles. In other cases, renal disease is associated with the presence of alteration within a gene or genes, but environmental factors are also necessary for the development of disease. Therefore, it seems that the analysis of genetic aspects should be a natural component of clinical and experimental studies. The goal of personalized medicine is to determine the right drug, for the right patient, at the right time. Whole-genome examinations may help to change the approach to the disease and the patient resulting in the creation of "personalized medicine" with new diagnostic and treatment strategies designed on the basis of genetic background of each individual. The identification of high-risk patients in pharmacogenomics analyses will help to avoid many unwarranted side effects while optimizing treatment efficacy for individual patients. Personalized therapies for kidney diseases are still at the preliminary stage mainly due to high costs of such analyses and the complex nature of human genome. This review will focus on several areas of interest: renal disease pathogenesis, diagnosis, treatment, rate of progression and the prediction of prognosis.

背景与目标： : 肾脏疾病的患病率正在上升，并达到成年人口的5-15%。肾脏损害与机体稳态紊乱以及外源性和内源性元素 (包括药物和代谢物) 之间平衡的丧失有关。研究表明，肾脏疾病不仅受环境影响，还受遗传因素影响。在某些情况下，该疾病是由单个基因突变引起的，当时的严重程度取决于一个或两个突变等位基因的存在。在其他情况下，肾脏疾病与一个或多个基因内的改变有关，但环境因素也是疾病发展所必需的。因此，似乎遗传方面的分析应该是临床和实验研究的自然组成部分。个性化医疗的目标是在正确的时间为正确的患者确定正确的药物。全基因组检查可能有助于改变疾病和患者的治疗方法，从而创建具有基于每个个体遗传背景设计的新诊断和治疗策略的 “个性化医学”。在药物基因组学分析中识别高危患者将有助于避免许多不必要的副作用，同时优化单个患者的治疗效果。肾脏疾病的个性化治疗仍处于初步阶段，这主要是由于此类分析的高昂成本和人类基因组的复杂性。这篇综述将集中在几个感兴趣的领域: 肾脏疾病的发病机制，诊断，治疗，进展率和预后预测。

BACKGROUND & AIMS: :This study, conducted over two time periods, aimed to evaluate the effectiveness of the diffusion of data, implementation of correctives measures and updated protocols in reducing time to reperfusion in acute myocardial infarction (AMI) management in the out-of-hospital setting. Mean (SD) time to hospital admission and to arterial puncture improved (58 (13) vs 67 (18) min, p = 0.03; and 82 (16) vs 95 (29) min, p = 0.02). The study, performed according to quality control programme methodology, showed that the chronology of AMI management could be improved by appropriate interventions and monitoring of intervention times.

背景与目标： : 这项研究在两个时间段内进行，旨在评估数据扩散的有效性，纠正措施的实施以及更新的方案在减少医院外急性心肌梗塞 (AMI) 管理中的再灌注时间方面的有效性设置。平均 (SD) 入院和动脉穿刺时间改善 (58 (13) vs 67 (18) 分钟，p = 0.03; 和82 (16) vs 95 (29) 分钟，p = 0.02)。根据质量控制计划方法进行的研究表明，可以通过适当的干预和监测干预时间来改善AMI管理的时间顺序。

BACKGROUND & AIMS: :Widespread interest in global health issues is a common characteristic of students and faculty in schools of public health and schools of medicine. Building on strong university-based and community-based programs in global health, the University of Washington has created a unique Department of Global Health that is housed jointly in its School of Public Health and Community Medicine and its School of Medicine. The creation of this department has generated significant enthusiasm throughout the university and the Seattle community as a new paradigm for addressing global health education, research, and service. Placing the new Department of Global Health in two university schools and finding the appropriate niche for the department among the university's many global health initiatives presented challenges, as well as opportunities. This article describes the goals of the department, the process by which it was created, and what it expects to accomplish.

背景与目标： : 对全球卫生问题的广泛关注是公共卫生学院和医学院的学生和教职员工的共同特征。华盛顿大学以强大的基于大学和社区的全球卫生计划为基础，创建了一个独特的全球卫生部门，该部门位于其公共卫生和社区医学学院及其医学院中。这个部门的创建在整个大学和西雅图社区产生了极大的热情，成为解决全球健康教育，研究和服务的新范式。将新的全球卫生部门安置在两所大学学校中，并在大学的许多全球卫生计划中找到适合该部门的利基市场，带来了挑战和机遇。本文介绍了该部门的目标，创建该部门的过程以及预期实现的目标。

BACKGROUND & AIMS: :7-hydroxymitragynine, a constituent of the Thai herbal medicine Mitragyna speciosa, has been found to have a potent opioid antinociceptive effect. In the present study, we investigated the mechanism of antinociception and the inhibitory effect on gastrointestinal transit of 7-hydroxymitragynine, and compared its effects with those of morphine. When administered subcutaneously to mice, 7-hydroxymitragynine produced antinociceptive effects about 5.7 and 4.4 times more potent than those of morphine in the tail-flick (ED50=0.80 mg/kg) and hot-plate (ED50=0.93 mg/kg) tests, respectively. The antinociceptive effect of 7-hydroxymitragynine was significantly blocked by the mu1/mu2-opioid receptor antagonist beta-funaltrexamine hydrochloride (beta-FNA) and the mu1-opioid receptor-selective antagonist naloxonazine in both tests. Thus, 7-hydroxymitragynine acts predominantly on mu-opioid receptors, especially on mu1-opioid receptors. Isolated tissue studies further supported its specificity for the mu-opioid receptors. Further, 7-hydroxymintragynine dose-dependently (ED50=1.19 mg/kg, s.c.) and significantly inhibited gastrointestinal transit in mice, as morphine does. The inhibitory effect was significantly antagonized by beta-FNA pretreatment, but slightly antagonized by naloxonazine. The ED50 value of 7-hydroxymitragynine on gastrointestinal transit was larger than its antinociceptive ED50 value. On the other hand, morphine significantly inhibits gastrointestinal transit at a much smaller dose than its antinociceptive dose. These results suggest that mu-opioid receptor mechanisms mediate the antinociceptive effect and inhibition of gastrointestinal transit. This compound induced more potent antinociceptive effects and was less constipating than morphine.

背景与目标： : 7-hydroxyymyramynine，泰国草药mitramyna speciosa的一种成分，已被发现具有有效的阿片类药物抗伤害作用。在本研究中，我们研究了7-羟基雌米雌酮的抗伤害感受机制和对胃肠道转运的抑制作用，并将其与吗啡的作用进行了比较。当皮下给药小鼠时，在甩尾 (ED50 = 0.80 mg/kg) 和热板 (ED50 = 0.93 mg/kg) 测试中，7-羟基肌酸产生的抗伤害感受作用比吗啡的作用强约5.7和4.4倍。在两次测试中，mu1/mu2-opioid受体拮抗剂 β-氟曲胺盐酸盐 (β-FNA) 和mu1-opioid受体选择性拮抗剂纳洛酮嗪均显着阻断了7-羟基酪氨酸的抗伤害感受作用。因此，7-羟甲基主要作用于 μ-阿片受体，尤其是mu1-opioid受体。孤立的组织研究进一步支持了其对 μ 阿片受体的特异性。此外，7-羟基喹啉呈剂量依赖性 (ED50 = 1.19 mg/kg，s.C.)，并显著抑制小鼠的胃肠转运，如吗啡。Β-FNA预处理可显着拮抗抑制作用，但纳洛酮嗪可轻微拮抗。7-羟基雌杆菌在胃肠道运输中的ED50值大于其抗伤害感受ED50值。另一方面，吗啡以比其抗伤害感受剂量小得多的剂量显着抑制胃肠道转运。这些结果表明，μ 阿片受体机制介导了抗伤害感受作用和抑制胃肠道转运。与吗啡相比，该化合物可产生更有效的抗伤害感受作用，并且便秘更少。

BACKGROUND & AIMS: :Post-remission therapy in acute myeloid leukemia (AML) remains problematic. It has been demonstrated that younger patients can maintain longer complete remissions (CR) with aggressive post-remission therapies after induction treatment: allogeneic (allo), autologous (auto) stem cell transplantation (SCT), or intensive chemotherapy (ICC). The purpose of our study was to identify the most important randomized and controlled studies comparing these three therapeutic options, in order to draw conclusions and possible suggestions for post-remission therapy of AML, according to the evidence based medicine (EBM) rules. We performed an exhaustive analysis of the literature, searching either in electronic databases or among the references of the identified articles (hand searching). We searched the MEDLINE computer database for reports from 1985 through January 2005 and selected for analysis the clinical trials conducted over adults affected by newly diagnosed AML aged less than 65 years. The study design had to satisfy strict methodological criteria and must consider global mortality and/or disease free survival as primary outcomes. Overall we found 7750 papers; by using the limits "clinical trial" as publication type, "all adults 19+ years", we were able to select 344 papers. Among these, a further selection was made, based on two main clinical queries: 1) is auto-SCT superior to ICC/no other therapy in improving DFS and/or OS in adult AML patients in first CR? 2) is allo-SCT superior to auto-SCT/other therapeutic options in improving DFS and/or OS in adult AML patients in first CR? Concerning the first query, a possible advantage of auto-SCT over ICC was not clearly supported by data from clinical trials; there is no evidence that auto-SCT is superior in terms of OS to chemotherapy. Nevertheless, the reported TRM has been significantly reduced within the past years. Thus, the percentage of patients suitable for auto-SCT in CR has increased. Moreover, the scarce data concerning the comparison between auto-SCT and chemotherapy in different subsets of patients are unable to suggest a differentiated approach in patients with high-risk, standard-risk or low-risk AML. Data from the literature show that patients with unfavorable risk disease are more often addressed to allo-SCT and patients with low-risk disease receive more often intensive consolidation chemotherapy. Concerning the second query, interpretation of data from the main prospective studies about the role of allo-SCT in previously untreated AML is not easy. The first problem is the lack of real randomized clinical trials; in fact, according to the reported studies, AML patients generally receive allo-SCT on the basis of donor availability (the so called "genetic randomization"). The second problem is the frequent absence of intention to treat analysis. Despite methodological limitations, it was possible to compare allo-SCT with auto-SCT on a donor versus no-donor analysis and within risk groups. No overall benefit of allo-grafting on survival was demonstrated by any trial. In conclusion, the EBM approach highlighted the limitations observed in the published studies concerning consolidation therapy in AML; some suggestions, emerging from non-randomized, as well as randomized studies, are adequate, but not conclusive. This point, coupled with the intrinsic complexity to study AML biological heterogeneity, is probably a major obstacle to draw conclusive evidences for consolidation therapy in AML. These observations should plan to address new randomized studies on AML therapy; however, due to the emergence of genetic subgroups and new drugs targeting specific abnormalities, these trials should probably be designed directly focusing on the single entities. In this way, the cure of AML could eventually become the cure of each specific AML subset with its peculiar biological, molecular and prognostic features.

背景与目标： : 急性髓系白血病 (AML) 的缓解后治疗仍然存在问题。已证明，年轻患者在诱导治疗后可以通过积极的缓解后疗法维持更长的完全缓解 (CR): 异体 (allo)，自体 (auto) 干细胞移植 (SCT) 或强化化疗 (ICC)。我们研究的目的是确定比较这三种治疗方案的最重要的随机和对照研究，以便根据循证医学 (EBM) 规则得出结论和可能的AML缓解后治疗建议。我们对文献进行了详尽的分析，在电子数据库中或在已识别文章的参考文献中进行搜索 (手工搜索)。我们在MEDLINE计算机数据库中搜索了通过2005年1月1985年的报告，并选择了针对年龄小于65岁的新诊断AML的成年人进行的临床试验进行分析。研究设计必须满足严格的方法学标准，并且必须将全球死亡率和/或无病生存率作为主要结果。总的来说，我们发现了7750篇论文; 通过使用限制 “临床试验” 作为出版类型，“所有成人19岁”，我们能够选择344篇论文。其中，基于两个主要的临床问题进行了进一步的选择: 1) 在改善首次CR的成年AML患者的DFS和/或OS方面，auto-SCT是否优于ICC/no其他疗法？2) 在改善首次CR的成年AML患者的DFS和/或OS方面，allo-SCT是否优于auto-SCT/其他治疗选择？关于第一个查询，临床试验数据并未明确支持auto-SCT优于ICC的可能优势; 没有证据表明auto-SCT在OS方面优于化疗。然而，在过去几年中，报告的TRM已大大减少。因此，CR中适合auto-SCT的患者百分比增加了。此外，关于不同患者亚组中auto-SCT和化疗之间比较的稀缺数据无法提示高风险，标准风险或低风险AML患者的差异化方法。来自文献的数据表明，患有不利风险疾病的患者更常接受allo-SCT治疗，而低风险疾病的患者更常接受强化强化化疗。关于第二个查询，对来自主要前瞻性研究的有关allo-SCT在先前未经治疗的AML中的作用的数据的解释并不容易。第一个问题是缺乏真正的随机临床试验; 实际上，根据报道的研究，AML患者通常根据供体的可用性接受allo-SCT (所谓的 “遗传随机化”)。第二个问题是经常缺乏治疗分析的意图。尽管方法上有局限性，但可以在供体分析与无供体分析以及风险组中比较allo-SCT与auto-SCT。任何试验都没有证明同种异体移植对生存率的总体益处。总之，EBM方法强调了在已发表的关于AML巩固治疗的研究中观察到的局限性; 从非随机和随机研究中提出的一些建议是足够的，但不是结论性的。这一点，加上研究AML生物异质性的内在复杂性，可能是为AML巩固治疗得出确凿证据的主要障碍。这些观察结果应计划解决有关AML治疗的新的随机研究; 但是，由于遗传亚组的出现和针对特定异常的新药的出现，这些试验可能应直接针对单个实体进行设计。这样，AML的治疗最终可以成为每个特定AML子集的治疗方法，具有其独特的生物学，分子和预后特征。

BACKGROUND & AIMS: :Pharmacotherapies for the behavioural and psychological symptoms of dementia are limited; novel agents for the symptoms are still needed. Herein, we report the case of an 80-year-old male patient with Alzheimer's disease whose severe agitation, insomnia and sexual delusions were successfully treated with a traditional natural Japanese (Kampo) medicine, keishi-ka-ryukotsu-borei-to. We found that administrating keishi-ka-ryukotsu-borei-to increased his serum luteinizing hormone level, which could be inversely associated with his behavioural and psychological symptoms. This report suggests that keishi-ka-ryukotsu-borei-to is a possible alternative treatment for the behavioural and psychological symptoms of dementia, especially sexual delusions.

背景与目标： : 针对痴呆症的行为和心理症状的药物疗法有限; 仍然需要针对这些症状的新型药物。在此，我们报告了一名80岁的男性阿尔茨海默氏病患者，其严重的躁动，失眠和性妄想已成功地用传统的天然日本 (Kampo) 药物keishi-ka-ryukotsu-borei-too治疗。我们发现，服用keishi-ka-ryukotsu-borei-会增加他的血清黄体生成激素水平，这可能与他的行为和心理症状成反比。该报告表明，keishi-ka-ryukotsu-borei-too可能是治疗痴呆症的行为和心理症状，尤其是性妄想的替代疗法。

BACKGROUND & AIMS: :Emergency physicians use diagnostic tests extensively, and the ability to order and interpret test results appropriately is a critical skill. An understanding of sensitivity, specificity, predictive values and likelihood ratios, as well as an awareness of the importance of pre-test probability, is essential. The purpose of this article is to explain, in a straightforward and clinically applicable manner, the core concepts related to diagnostic testing.

背景与目标： : 急诊医生广泛使用诊断测试，并且能够适当地排序和解释测试结果是一项关键技能。了解敏感性，特异性，预测值和似然比，以及了解测试前概率的重要性至关重要。本文的目的是以一种直接且临床适用的方式解释与诊断测试相关的核心概念。

BACKGROUND & AIMS: :What is the Best Practice for automated inference in Medical Decision Support for personalized medicine? A known system already exists as Dirac's inference system from quantum mechanics (QM) using bra-kets and bras where A and B are states, events, or measurements representing, say, clinical and biomedical rules. Dirac's system should theoretically be the universal best practice for all inference, though QM is notorious as sometimes leading to bizarre conclusions that appear not to be applicable to the macroscopic world of everyday world human experience and medical practice. It is here argued that this apparent difficulty vanishes if QM is assigned one new multiplication function @, which conserves conditionality appropriately, making QM applicable to classical inference including a quantitative form of the predicate calculus. An alternative interpretation with the same consequences is if every i = radical-1 in Dirac's QM is replaced by h, an entity distinct from 1 and i and arguably a hidden root of 1 such that h2 = 1. With that exception, this paper is thus primarily a review of the application of Dirac's system, by application of linear algebra in the complex domain to help manipulate information about associations and ontology in complicated data. Any combined bra-ket can be shown to be composed only of the sum of QM-like bra and ket weights c(), times an exponential function of Fano's mutual information measure I(A; B) about the association between A and B, that is, an association rule from data mining. With the weights and Fano measure re-expressed as expectations on finite data using Riemann's Incomplete (i.e., Generalized) Zeta Functions, actual counts of observations for real world sparse data can be readily utilized. Finally, the paper compares identical character, distinguishability of states events or measurements, correlation, mutual information, and orthogonal character, important issues in data mining and biomedical analytics, as in QM.

BACKGROUND & AIMS: :Cannabis as a medicine was used before the Christian era in Asia, mainly in India. The introduction of cannabis in the Western medicine occurred in the midst of the 19th century, reaching the climax in the last decade of that century, with the availability and usage of cannabis extracts or tinctures. In the first decades of the 20th century, the Western medical use of cannabis significantly decreased largely due to difficulties to obtain consistent results from batches of plant material of different potencies. The identification of the chemical structure of cannabis components and the possibility of obtaining its pure constituents were related to a significant increase in scientific interest in such plant, since 1965. This interest was renewed in the 1990's with the description of cannabinoid receptors and the identification of an endogenous cannabinoid system in the brain. A new and more consistent cycle of the use of cannabis derivatives as medication begins, since treatment effectiveness and safety started to be scientifically proven.

背景与目标： : 大麻作为药物在基督教时代之前在亚洲使用，主要在印度。西药中大麻的引入发生在19世纪之中，随着大麻提取物或酊剂的供应和使用，在那个世纪的最后十年达到了高潮。在20世纪的头几十年中，由于难以从不同功效的植物材料批次中获得一致的结果，西方医学对大麻的使用显着减少。1965年，鉴定大麻成分的化学结构以及获得其纯成分的可能性与对这种植物的科学兴趣的显着提高有关。20世纪90年代对大麻素受体的描述和对大脑中内源性大麻素系统的鉴定，重新激发了这种兴趣。由于治疗有效性和安全性开始得到科学证明，因此开始了使用大麻衍生物作为药物的新的，更一致的周期。

BACKGROUND & AIMS: OBJECTIVE:To determine if iron containing "siderotic" nodules detected at magnetic resonance (MR) imaging are regenerative (RN) or dysplastic (DN) and to attempt to identify features that may distinguish them. MATERIAL AND METHODS:MR imaging (1.5 T) was performed on 77 cirrhotic patients who underwent orthotopic liver transplantation within 0-117 days (mean 30 days) of MR imaging. Two readers retrospectively evaluated breath-hold gradient-echo pulse sequences (echo time > or =9.0 ms, flip angle < or =45 degrees) for the presence of hypointense nodules, which were classified as micronodular (< or =3 mm), macronodular (>3 mm), or mixed. Nodule distribution was classified as focal (<5), scattered (5-20), or diffuse (>20) per slice. Thin section pathologic correlation was available in all cases, and Prussian blue iron stains were performed. RESULTS:Of 35 patients with pathologically proven siderotic nodules, 10 (29%) had at least 2 siderotic DN. MR detected siderotic nodules in 10 of 10 (100%) patients with siderotic DN and RN, and in 18 of 25 patients (72%) with siderotic RN only. CONCLUSION:Siderotic RN cannot be reliably distinguished from siderotic DN with MR imaging, and therefore the widely used term "siderotic regenerative nodule" should be avoided and replaced by "siderotic nodule."

背景与目标：

BACKGROUND & AIMS: :In 1998 the Society for Academic Emergency Medicine's (SAEM's) Board of Directors asked the SAEM Public Health and Education Task Force to develop recommendations for prevention, screening, and counseling activities to be conducted in emergency departments (EDs). The Task Force's work was divided into two phases: 1) a discussion of the rationale for preventive services in the ED, along with generation of a preliminary list of prevention activities that could be studied for ED implementation; and 2) a formal evidence-based review of topics chosen from the preliminary list, along with recommendations for ED implementation and further study. This paper represents Phase I of the project. Phase II, the formal evidence-based review and recommendations, is published separately in this issue.

背景与目标： : 1998年，学术急诊医学协会 (SAEM's) 董事会要求SAEM公共卫生和教育工作组为在急诊科 (EDs) 进行的预防，筛查和咨询活动制定建议。专责小组的工作分为两个阶段: 1) 讨论在ED中提供预防服务的理由，并生成可研究用于ED实施的预防活动的初步清单; 2) 对从初步清单中选择的主题进行正式的循证审查，以及对ED实施和进一步研究的建议。本文代表了该项目的第一阶段。第二阶段，正式的循证审查和建议，在本期单独发表。

BACKGROUND & AIMS: BACKGROUND:The NHS plan proposes up to 1000 general practitioners with a special interest (GPwSIs) by 2004.1,2 Following a meeting organised by the General Practice Airways Group (GPIAG) Williams et al, in their discussion document3 outlined the possible roles of a GPwSI, using respiratory medicine as a model. A GPIAG working party then met up with the representatives of the Royal College of General Practitioners (RCGP) and produced a draft working document which could give guidance to primary care organisations (PCO's) about the the possible role of a GPwSI in respiratory medicine together with the core competencies needed to fulfil such a role. This stated that the role of a GpwSI in respiratory medicine is primarily one of leadership and service development (i.e as a GP lead in respiratory medicine within a PCO). This is contrast to other specialities such as ENT or dermatology where the GPwSI has a predominantly clinical role. In addition the draft document envisaged that the "gold standard" qualification for a GPwSI would be a Diploma in Respiratory Medicine. The GPIAG draft document was modified after consultation with the British Thoracic Society, Royal College of Physicians, Royal College of Nursing, National Asthma Campaign, National Respiratory Training Centre and the Respiratory Education Training Centre and submitted to the RCGP. The resultant framework, published in this issue (pp38-41), is a chimera of a generic RCGP framework (for example, certain competencies such as negotiating skills will be common to all specialities) with the respiratory disease specific framework of the GPIAG draft document.

背景与目标： 背景: NHS计划提出了多达1000名具有特殊兴趣的全科医生 (GPwSIs) 2004年。1,2在由普通实践航空集团 (GPIAG) Williams等人组织的一次会议之后，在他们的讨论文件3中概述了使用呼吸医学作为模型的GPwSI的可能作用。然后，一个GPIAG工作组会见了皇家全科医生学院 (RCGP) 的代表，并编写了一份工作文件草案，该文件草案可以为初级保健组织 (PCO) 提供有关GPwSI在呼吸医学中的可能作用以及履行这一职责所需的核心能力的指导。这表明GpwSI在呼吸医学中的作用主要是领导和服务发展之一 (即作为PCO中呼吸医学的GP领导者)。这与GPwSI主要具有临床作用的其他专业 (例如耳鼻喉科或皮肤病学) 形成鲜明对比。此外，文件草案设想，GPwSI的 “金标准” 资格将是呼吸医学文凭。在与英国胸科学会，皇家内科医学院，皇家护理学院，国家哮喘运动，国家呼吸训练中心和呼吸教育培训中心协商后，对GPIAG文件草案进行了修改，并提交给了RCGP。在本期 (pp38-41) 中发布的最终框架是通用RCGP框架的嵌合体 (例如，某些能力 (例如，谈判技巧) 将是所有专业人员所共有的) 与GPIAG草案文件的呼吸疾病特定框架。