BACKGROUND & AIMS: :We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15), the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 (p = 0.005). The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.

背景与目标： ：我们开发了一种新颖的多层面心理社会干预计划，涉及筛查心理困扰和综合支持，包括由心理健康专业人员提供的量身定制的心理治疗和药物治疗。本研究的目的是调查干预计划的可行性及其对减少复发性乳腺癌患者所经历的临床心理困扰的初步有用性。参加了为期3个月的干预计划的受试者完成了精神病学诊断性访谈，并就心理困扰，创伤压力和生活质量进行了几项自我报告的措施。评估是在干预之前（T1），干预之后（T2）和干预之后3个月（T3）进行的。共有50名患者参加了该研究。干预计划的参与率和遵守率分别为85％和86％。尽管T2的精神疾病比例（11.6％）与T1（22.0％）的比例无显着差异（p = 0.15），但T3的精神疾病的比例（7.7％）较T1（p = 0.005）。新的干预计划是可行的，是减少临床表现出的心理困扰的有前途的策略，因此有必要进行进一步的对照研究。

BACKGROUND & AIMS: BACKGROUND:Web-based alcohol interventions are a promising way to reduce alcohol consumption because of their anonymity and the possibility of reaching a high numbers of individuals including heavy drinkers. However, Web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in Web-based alcohol interventions as compared with individuals with lower alcohol consumption. OBJECTIVES:The aim of this study was to examine the attrition rate and predictors of attrition in a Web-based intervention study on alcohol consumption. METHODS:The analysis of the predictors of attrition rate was performed on data collected in a Web-based randomized control trial. Data collection took place at the University of Konstanz, Germany. A total of 898 people, which consisted of 46.8% males (420/898) and 53.2% females (478/898) with a mean age of 23.57 years (SD 5.19), initially volunteered to participate in a Web-based intervention study to reduce alcohol consumption. Out of the sample, 86.9% (781/898) were students. Participants were classified as non-completers (439/898, 48.9%) if they did not complete the Web-based intervention. Potential predictors of attrition were self-reported: alcohol consumption in the last seven days, per week, from Monday to Thursday, on weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the Drinking Motive Questionnaire (DMQ-R SF). RESULTS:Significant differences between completers and non-completers emerged regarding alcohol consumption in the last seven days (B=-.02, P=.05, 95% CI [0.97-1.00]), on weekends (B=-.05, P=.003, 95% CI [0.92-0.98]), the AUDIT (B=-.06, P=.007, 95% CI [0.90-0.98], and the status as a student (B=.72, P=.001, 95% CI [1.35-3.11]). Most importantly, non-completers had a significantly higher alcohol consumption compared with completers. CONCLUSIONS:Hazardous alcohol consumption appears to be a key factor of the dropout rate in a Web-based alcohol intervention study. Thus, it is important to develop strategies to keep participants who are at high risk in Web-based interventions.

背景与目标： 背景：基于网络的酒精干预是减少酒精消费的一种有前途的方法，因为它们的匿名性和与包括重度饮酒者在内的大量个人接触的可能性。但是，基于Web的干预措施通常具有高流失率的特点。迄今为止，很少有研究调查酒精摄入量较高的人是否比酒精摄入量较低的人在基于网络的酒精干预中显示出更高的减员率。
目的：本研究的目的是在基于网络的酒精摄入量干预研究中检查流失率和流失预测因子。
方法：对基于网络的随机对照试验中收集的数据进行了流失率预测指标的分析。数据收集在德国康斯坦茨大学进行。共有898人（平均年龄为23.57岁（SD 5.19），其中男性为46.8％，男性为420/898，女性为53.2％，男性为478/898），最初自愿参加了一项基于网络的干预研究，以期减少饮酒。在样本中，有86.9％（781/898）是学生。如果参与者未完成基于Web的干预，则归为未完成（439/898，48.9％）。自我预测潜在的损耗的因素：每周最近7天（周一至周四，周末）饮酒，通过酒精使用障碍识别测试（AUDIT）衡量的过度饮酒行为以及通过饮酒量度的饮酒动机动机问卷（DMQ-R SF）。
结果：在最近7天（B =-。02，P = .05、95％CI [0.97-1.00]），周末（B =-。05， P = .003、95％CI [0.92-0.98]），审核（B =-。06，P = .007、95％CI [0.90-0.98]）和学生身份（B = .72， P = .001，95％CI [1.35-3.11]），最重要的是，未完成者的酒精消耗量明显高于完成者。
结论：在基于网络的酒精干预研究中，有害的酒精消费似乎是辍学率的关键因素。因此，制定策略以使参加基于Web的干预措施的高风险参与者保持重要。

BACKGROUND & AIMS: BACKGROUND:The routine implementation of sternal precautions to prevent sternal complications that restrict the use of the upper limbs is currently worldwide practice following a median sternotomy. However, evidence is limited and drawn primarily from cadaver studies and orthopaedic research. Sternal precautions may delay recovery, prolong hospital discharge and be overly restrictive. Recent research has shown that upper limb exercise reduces post-operative sternal pain and results in minimal micromotion between the sternal edges as measured by ultrasound. The aims of this study are to evaluate the effects of modified sternal precautions on physical function, pain, recovery and health-related quality of life after cardiac surgery. METHODS/DESIGN:This study is a phase II, double-blind, randomised controlled trial with concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. Patients (n = 72) will be recruited following cardiac surgery via a median sternotomy. Sample size calculations were based on the minimal important difference (two points) for the primary outcome: Short Physical Performance Battery. Thirty-six participants are required per group to counter dropout (20%). All participants will be randomised to receive either standard or modified sternal precautions. The intervention group will receive guidelines encouraging the safe use of the upper limbs. Secondary outcomes are upper limb function, pain, kinesiophobia and health-related quality of life. Descriptive statistics will be used to summarise data. The primary hypothesis will be examined by repeated-measures analysis of variance to evaluate the changes from baseline to 4 weeks post-operatively in the intervention arm compared with the usual-care arm. In all tests to be conducted, a p value <0.05 (two-tailed) will be considered statistically significant, and confidence intervals will be reported. DISCUSSION:The Sternal Management Accelerated Recovery Trial (S.M.A.R.T.) is a two-centre randomised controlled trial powered and designed to investigate whether the effects of modifying sternal precautions to include the safe use of the upper limbs and trunk impact patients' physical function and recovery following cardiac surgery via median sternotomy. TRIAL REGISTRATION:Australian and New Zealand Clinical Trials Registry identifier: ACTRN12615000968572 . Registered on 16 September 2015 (prospectively registered).

背景与目标： 背景技术：正中胸骨切开术是目前世界范围内普遍采用的预防胸骨并发症限制上肢使用的胸骨预防措施的常规措施。但是，证据是有限的，主要来自尸体研究和骨科研究。胸骨预防措施可能会延迟康复，延长出院时间，并且限制过多。最近的研究表明，上肢锻炼可减轻手术后的胸骨疼痛，并通过超声测量使胸骨边缘之间的微动最小。这项研究的目的是评估改良的胸骨预防措施对心脏手术后身体机能，疼痛，恢复以及与健康相关的生活质量的影响。
方法/设计：该研究是一项II期，双盲，随机对照试验，具有隐蔽分配，患者和评估者盲目性和意向性治疗分析。心脏手术后，将通过正中胸骨切开术招募患者（n = 72）。样本量的计算是基于以下主要方面的最小重要差异（两点）：身体机能短。每个小组需要三十六名参与者来应对辍学（20％）。所有参与者将被随机分配接受标准或改良的胸骨预防措施。干预小组将收到指导原则，以鼓励安全使用上肢。次要结果是上肢功能，疼痛，运动恐惧症和与健康相关的生活质量。描述性统计将用于汇总数据。主要假设将通过重复测量方差分析进行检验，以评估与常规护理组相比，干预组从基线到术后4周的变化。在将要进行的所有测试中，p值<0.05（两尾）将被认为具有统计学显着性，并将报告置信区间。
讨论：胸骨管理加速恢复试验（SMART）是一项两中心的随机对照试验，旨在研究修改胸骨预防措施（包括安全使用上肢和躯干）的影响是否影响患者的身体功能和术后康复通过正中胸骨切开术进行心脏手术。
试验注册：澳大利亚和新西兰临床试验注册标识符：ACTRN12615000968572。已于2015年9月16日注册（可能已注册）。

BACKGROUND & AIMS: BACKGROUND:Unstable angina and non-ST elevation myocardial infarction (NSTEMI) are common acute coronary events. Homocysteine is a novel risk factor for coronary heart diseases. Together with the conventional risk factors, they may affect the outcome of non-ST coronary events. OBJECTIVE:This study aims to determine the effect of clinical risk factors that are responsible for the occurrence of mortality, and the composite outcome of mortality, nonfatal myocardial infarction and serious rehospitalization within 6 months after the onset of non-ST acute coronary syndromes. METHODS:A total of 124 Filipino patients were interviewed and tested for blood homocysteine levels and lipid profiles. Outcomes were assessed after 6 months. RESULTS:Homocysteinemia (>16 micromol/l) is associated with increased mortality and composite outcomes (mortality, nonfatal reinfarction, and serious rehospitalization), even if adjusted for conventional risk factors. No association was detected for the conventional risk factors. Earlier acute coronary syndrome was found to be positively associated with mortality and the composite outcomes. Early stroke is associated with increased composite outcomes, whereas greater mortality and adverse outcomes were observed in NSTEMI compared with intermediate-risk unstable angina. CONCLUSION:Increased homocysteine level is associated with mortality and serious nonfatal outcomes in patients with unstable angina and NSTEMI.

背景与目标： 背景：不稳定型心绞痛和非ST段抬高型心肌梗塞（NSTEMI）是常见的急性冠状动脉事件。同型半胱氨酸是冠心病的一种新的危险因素。与常规危险因素一起，它们可能会影响非ST冠状动脉事件的结果。
目的：本研究旨在确定导致非ST急性冠状动脉综合征发病后6个月内死亡发生的临床危险因素以及死亡率，非致命性心肌梗塞和严重再次住院的综合结果的影响。
方法：总共对124名菲律宾患者进行了访谈并测试了其血液中同型半胱氨酸水平和血脂水平。 6个月后评估结果。
结果：高半胱氨酸血症（> 16 micromol / l）与死亡率增加和综合结局（死亡率，非致命性再梗塞和严重的住院治疗）相关，即使已针对常规危险因素进行了调整。常规危险因素未发现相关性。早期发现急性冠状动脉综合征与死亡率和综合结局呈正相关。早期卒中与综合预后增加相关，而与中等风险的不稳定型心绞痛相比，NSTEMI观察到更高的死亡率和不良预后。
结论：不稳定型心绞痛和NSTEMI患者高半胱氨酸水平升高与死亡率和严重的非致命性预后有关。

BACKGROUND & AIMS: OBJECTIVE:To study the influence of clinical and angiographic factors on global and regional left ventricular (LV) function after rescue percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). METHODS:We performed repeat cardiac catheterization in 102 patients who underwent rescue PCI at our centre. Eighty-two patients had suitable baseline and follow-up ventriculograms, which were analyzed offline by an automated edge detection technique. RESULTS:The mean (standard deviation [SD]) follow-up period was 22 (15) months. PCI was completed in all patients between 3 to 24 hours following the onset of pain. Improved global and regional LV systolic function was observed in 55 (67%) patients, and deterioration in 27 (33%). On univariate analysis, baseline ejection fraction (p = 0.005) and coronary stenting (p = 0.05) were associated with improved LV systolic function. Preprocedure TIMI flow, postprocedure TMP grade, time-to-reperfusion, and use of glycoprotein (GP) IIb/IIIa inhibitors did not influence LV systolic function. On multivariate analysis, ejection fraction at the time of rescue PCI (odds ratio [95% confidence interval]: 0.427 [0.234, 0.780]; p = 0.006) and stenting 3.944 (1.182, 13.156; p = 0.026) were predictors of improved LV systolic function. CONCLUSION:Successful rescue PCI was associated with improved LV function at follow up in the majority of patients. Stenting, but not GP IIb/IIIa inhibitor therapy, predicted improved LV function in the area supplied by the infarct-related artery. These improvements in regional wall motion were independent of the time taken to establish reperfusion, provided the intervention was carried out between 3 to 24 hours from the onset of pain.

背景与目标： 目的：探讨急性心肌梗死（AMI）急诊经皮冠状动脉介入治疗（PCI）后临床和血管造影因素对整体和区域左心室（LV）功能的影响。
方法：我们对102名在我们中心接受了急诊PCI的患者进行了重复心脏导管插入术。八十二例患者有合适的基线和心室图，并通过自动边缘检测技术对其进行了离线分析。
结果：平均随访时间（标准差[SD]）为22（15）个月。疼痛发作后3至24小时内，所有患者均完成PCI。 55例（67％）患者的整体和区域左室收缩功能得到改善，而27例（33％）患者恶化。单因素分析显示，基线射血分数（p = 0.005）和冠状动脉支架置入术（p = 0.05）与左室收缩功能改善有关。术前TIMI流量，术后TMP分级，再灌注时间以及糖蛋白（GP）IIb / IIIa抑制剂的使用均不影响LV收缩功能。在多变量分析中，抢救PCI时的射血分数（几率[95％置信区间]：0.427 [0.234，0.780]； p = 0.006）和支架置入3.944（1.182，13.156; p = 0.026）是LV改善的预测指标收缩功能。
结论：大多数患者随访中成功的抢救性PCI与左室功能改善有关。支架术（但不是GP IIb / IIIa抑制剂疗法）预示着梗死相关动脉所供应区域的LV功能会改善。这些区域壁运动的改善与建立再灌注所需的时间无关，只要在疼痛发作后的3至24小时内进行干预即可。

BACKGROUND & AIMS: BACKGROUND:Among the most serious sequelae to an initial episode of Major Depressive Disorder (MDD) during adolescence is the significant increase in the probability of recurrence. This study reports on an integrated CBT/IPT program, provided in a group format, that was developed to decrease the rate of MDD recurrence in emerging adults. METHODS:Participants were 89 young adults who were not depressed at study entry but had experienced MDD during adolescence. Participants were assigned to a CBT/IPT prevention program or to an assessment only control condition and were followed through the first 2 years of college. RESULTS:Risk for MDD recurrence was reduced more than 50% for the prevention program participants compared to assessment only controls. The intervention also conferred beneficial effects on academic performance for those students who completed the majority of the group sessions. LIMITATIONS:The study included a self-selected sample of emerging adults who were aware of their history of depression. Due to the small sample size, it will be important to evaluate similar interventions in adequately-powered trials to determine if this is a replicable finding. CONCLUSIONS:With 51% of the assessment only participants experiencing a MDD recurrence during the first 2 years of college, these findings support the need for programs designed to prevent MDD recurrence in young adults. The current program, based on IPT and CBT principles, appears to reduce the rate of MDD recurrence among previously depressed emerging adults.

背景与目标： 背景：在青春期主要抑郁症（MDD）初期发作的最严重后遗症中，复发几率显着增加。这项研究报告了以小组形式提供的综合CBT / IPT计划，该计划旨在降低新兴成年人的MDD复发率。
方法：参与者为89位年轻成年人，他们在入学时并未感到沮丧，但在青春期曾经历过MDD。参与者被分配到CBT / IPT预防计划或仅评估控制状况，并被跟踪到大学学习的前两年。
结果：与仅评估对照组相比，预防计划参与者的MDD复发风险降低了50％以上。干预还为完成大部分小组课程的学生们的学业成绩带来了有益的影响。
局限性：该研究包括自我选择的新兴成年人的样本，这些成年人意识到他们的抑郁症史。由于样本量较小，因此在足够有力的试验中评估类似干预措施，以确定这是否是可重复的发现，这一点很重要。
结论：只有51％的评估参与者在大学的头两年内经历了MDD复发，这些发现支持需要制定旨在预防年轻人MDD复发的计划。基于IPT和CBT原则的当前计划似乎降低了先前抑郁的新兴成年人中MDD复发率。

BACKGROUND & AIMS: :Forty patients who had been treated for three years in an ad-hoc, assertive treatment team for patients who had suffered a first psychotic episode were compared to forty patients who had been followed up after a first psychotic episode in a community mental health team. All patients had suffered a first or early psychotic episode. The main differences between the two teams was that the ad-hoc team was assertive in its approach, offered more structured psycho-education, relapse prevention and psycho-social interventions, and had a policy of using atypical anti-psychotics at the lowest effective dose. There were many differences in outcome measures at the end of three years between the two groups. The EI patients are more likely to be taking medication at the end of three years. They are more compliant with medication. They are more likely to be prescribed atypical medication. The EI patients are more likely to have returned to work or education. The EI patients are more likely to remain living with their families. They are less likely to suffer depression to the extent of requiring anti-depressants. They appear to commit less suicide attempts. The patients in the EI service also appear to be less likely to suffer relapse and re-hospitalisation, and are less likely to have involuntary admission to hospital. They have systematic relapse prevention plans based on early warning signs. They and their families receive more psycho-education. These indications suggest that the EI patients are at the end of three years better able to manage their illness/vulnerability on their own than the CMHT patients. More patients in the EI group stopped using illicit drugs than in the CMHT group. All the above changes were statistically significant except for the number of patients who stopped using illicit drugs. In this case it is believed that the sample size was too small to demonstrate significance. These results suggest that an ad-hoc early intervention team is more effective than standard community mental health team in treating psychotic illness.

背景与目标： ：在社区精神卫生小组中，将40例在第一次精神病发作后接受过专心，果断的治疗团队治疗的患者与40例在第一次精神病发作后进行了随访的患者进行了比较。所有患者均经历了第一次或早期精神病发作。这两个团队之间的主要区别在于，特设团队在方法上比较果断，提供了更有条理的心理教育，预防复发和心理社会干预措施，并制定了以最低有效剂量使用非典型抗精神病药的政策。两组在三年结束时的结局指标之间存在许多差异。 EI患者在三年结束时更有可能服用药物。他们对药物的依从性更高。他们更有可能被开具非典型药物。 EI患者更有可能重返工作岗位或接受教育。 EI患者更有可能继续与家人同住。他们不太可能因需要抗抑郁药而患上抑郁症。他们似乎没有自杀的企图。 EI服务中的患者似乎也不太可能遭受复发和再次住院，并且也不太可能自愿住院。他们根据预警信号制定了系统的预防复发计划。他们和他们的家人接受了更多的心理教育。这些迹象表明，与CMHT患者相比，EI患者在三年结束时能够更好地自行控制疾病/脆弱性。与CMHT组相比，EI组中停止使用违禁药物的患者更多。除停止使用违禁药物的患者人数外，以上所有变化均具有统计学意义。在这种情况下，可以认为样本量太小而无法显示出显着性。这些结果表明，特设的早期干预小组在治疗精神病方面比标准的社区精神卫生小组更有效。

BACKGROUND & AIMS: OBJECTIVES:To assess the influence of race on long-term outcomes following percutaneous coronary intervention (PCI) with paclitaxel-eluting stents (PES). BACKGROUND:Data on the influence of race on long-term outcomes following PCI with drug-eluting stents are limited because of severe underrepresentation of minority populations in randomized trials. METHODS:We compared 5-year outcomes of 2,301 whites, 127 blacks, and 169 Asians treated with PES in the TAXUS IV, V, and ATLAS trials. Outcomes were adjusted using a propensity score logistic regression model with 1:4 matching. RESULTS:Blacks were more likely than whites to be female, have a history of hypertension, diabetes mellitus, congestive heart failure, and stroke, but were less likely to have prior coronary artery disease. Compared with whites, Asians were younger, more likely to be male, have stable angina, and left anterior descending disease, and less likely to have silent ischemia, previous coronary artery bypass surgery, prior coronary artery disease, diabetes mellitus, peripheral vascular disease, and to receive glycoprotein IIb/IIIa inhibitors. Despite higher antiplatelet compliance, the adjusted 5-year rates of myocardial infarction (15.4% vs. 5.4%, P < 0.001) and stent thrombosis (5.6% vs. 1.1%, P = 0.002) were higher in blacks than whites. Despite lower antiplatelet compliance, Asians had no differences in myocardial infarction and stent thrombosis compared with whites. Mortality and revascularization rates were similar between the three groups. CONCLUSIONS:The long-term risk of major thrombotic events after PCI with PES was higher in blacks, but not Asians, compared with whites. The mechanisms underlying these racial differences warrant further investigation.

背景与目标： 目的：评估种族对紫杉醇洗脱支架（PES）经皮冠状动脉介入治疗（PCI）后长期结局的影响。
背景：由于随机试验中少数群体的严重代表性不足，有关种族对药物洗脱支架PCI后长期预后影响的数据有限。
方法：在TAXUS IV，V和ATLAS试验中，我们比较了接受PES治疗的2,301名白人，127名黑人和169名亚洲人的5年结局。结果使用倾向评分逻辑回归模型与1：4匹配进行调整。
结果：黑人比白人更有可能是女性，有高血压，糖尿病，充血性心力衰竭和中风的病史，但以前患有冠状动脉疾病的可能性较小。与白人相比，亚洲人更年轻，男性更容易，有稳定的心绞痛和左前降支疾病，无声缺血，先前进行冠状动脉搭桥手术，先前有冠状动脉疾病，糖尿病，周围血管疾病，并接受糖蛋白IIb / IIIa抑制剂。尽管抗血小板依从性更高，但黑人的白人校正后5年心肌梗塞发生率（15.4％vs. 5.4％，P <0.001）和支架内血栓形成（5.6％vs. 1.1％，P = 0.002）高于白人。尽管抗血小板依从性较低，但与白人相比，亚洲人在心肌梗塞和支架血栓形成方面无差异。两组的死亡率和血运重建率相似。
结论：与白人相比，黑人（而非亚洲人）的PCI与PES术后PCI发生重大血栓事件的长期风险更高。这些种族差异的潜在机制值得进一步调查。

BACKGROUND & AIMS: BACKGROUND:To investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18-24 months, using data from the Korean Neonatal Network (KNN). METHODS:Data from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18-24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery. RESULTS:A total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery (P value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1-2.6 and 2.3 with 95% CI of 1.1-4.9. CONCLUSION:Approximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18-24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.

背景与目标： 背景：使用韩国新生儿网络（KNN）的数据，调查极低出生体重（VLBW）婴儿的外科手术发生率以及18个月至24个月校正年龄（CA）手术对神经发育结局的影响。
方法：本研究分析了2013年至2016年间在KNN出生和登记的7885名VLBW婴儿的数据。分析了各种外科手术的发生率和相关的发病率。比较了有手术和无手术的婴儿（2013年至2015年出生，n = 3,777）在18-24个月CA时的长期神经发育结局。
结果：在新生儿重症监护病房（NICU）住院期间，共有7,885例婴儿中的1,509例接受了手术干预。外科手术治疗动脉导管未闭（n = 840），然后进行激光治疗以治疗由于视网膜穿孔而导致的早产儿视网膜病变和剖腹手术。与未接受手术的婴儿相比，接受手术的婴儿死亡率更高，神经发育障碍更大（P值均<0.01）。在多变量分析中，与未进行手术的患者相比，单次或多次手术增加了神经发育障碍的风险，调整后的优势比（OR）为1.6，95％置信区间（CI）为1.1-2.6，2.3为95％CI为1.1-4.9。
结论：在新生儿重症监护病房住院期间，大约五分之一的VLBW婴儿接受了一项或多项外科手术。在CA 18-24个月的随访中，外科手术对长期神经发育结局的影响得以持续。与仅进行一次手术或未进行可能的混杂因素调整后不进行任何手术的婴儿相比，进行多次手术的婴儿神经发育受损的风险增加。

BACKGROUND & AIMS: :One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.

背景与目标： ：南非是世界上最严重的HIV / AIDS流行病之一，异性接触是HIV传播的主要方式。 15-24岁的年轻人，尤其是女性，在新感染中占很大比例。因此，迫切需要改变行为的干预措施，以减少南非青少年中艾滋病毒的发生率。但是，很少有这类干预措施对南非青少年特别是年轻青少年具有有效的疗效。最近一项“让我们保护我们的未来！”的集群随机对照试验。与对照干预相比，南非6级（平均年龄= 12.4岁）青少年的HIV / STD降低风险干预措施发现自我报告的性风险行为显着降低。本文介绍了干预措施，社会认知理论的使用以及采取合理的行动方法来开发干预措施，形成性研究如何告知其发展以及干预措施的可接受性。讨论了为撒哈拉以南非洲地区的青少年设计和实施降低艾滋病毒/性病风险的干预措施所面临的挑战。

BACKGROUND & AIMS: INTRODUCTION:Data supports that motor skills are an underlying mechanism that influence physical activity along with perceived motor and physical competence, but the relationship between motor skills and physical activity during the early years is unclear. The goal of this study, Promoting Activity and Trajectories of Health (PATH) for Children, is to examine and compare the immediate (pre-test to post-test) and sustained (3-year follow-up) effect of an intervention on motor performance, physical activity and perceived physical competence to a control condition (ie, standard practice) in preschool-age children. METHODS AND ANALYSIS:The PATH study is a two-cohort, randomised cluster clinical trial. 300 children between the ages of >3.5 to 5 years of age will be randomised to the motor skill intervention (n=153) or control (n=147) condition. Each assessment involves a measure of motor skill performance; product and process, seven consecutive days of physical activity monitoring and perceived physical competence. These measures will be assessed before and after the intervention (pre-test to post-test) and then each academic year across 3 years, grades kindergarten, first grade and second grade (3-year follow-up). To assess the clustered longitudinal effect of the intervention on outcome measures, random-effects models (eg, mixed model regression, growth curve modelling and structural equation modelling) will be used. The PATH study addresses gaps in paediatric exercise science research. Findings hold the potential to help shape public health and educational policies and interventions that support healthy development and active living during the early years. ETHICS AND DISSEMINATION:Ethical approval for this study was obtained through the Health Sciences and Behavioral Sciences Institutional Review Board, University of Michigan (HUM00133319). The PATH study is funded by the National Institutes of Health. Findings will be disseminated via print, online media, dissemination events and practitioner and/or research journals. TRIAL REGISTRATION NUMBER:NHLBI ClinicalTrials.gov Identifier, NCT03189862. Registered 17 August 2017, https://clinicaltrials.gov/ct2/show/NCT03189862.

背景与目标： 简介：数据支持运动技能是影响身体活动以及感知的运动和身体能力的基本机制，但是早期运动技能和身体活动之间的关系尚不清楚。这项研究的目标是“促进儿童的活动和健康轨迹（PATH）”，以检查并比较干预对运动的即时效果（测试前至测试后）和持续（3年随访）。学龄前儿童在控制条件下的表现，体育活动和感知的身体能力（即标准做法）。
方法与分析：PATH研究是一项两队列，随机分组的临床试验。 300名年龄大于3.5至5岁的儿童将被随机分配到运动技能干预（n = 153）或对照（n = 147）的情况下。每次评估都涉及一项运动技能表现的量度；产品和过程，连续七天进行身体活动监测和感知的身体能力。这些措施将在干预前后进行评估（从测试前到测试后），然后在3年，幼儿园，一年级和二年级的每个学年（三年随访）中进行评估。为了评估干预措施对结果测度的聚集纵向效应，将使用随机效应模型（例如，混合模型回归，增长曲线建模和结构方程建模）。 PATH研究解决了小儿运动科学研究中的空白。研究结果有潜力帮助制定公共卫生和教育政策以及干预措施，以支持早期的健康发展和积极的生活。
道德与传播：通过密歇根大学健康科学与行为科学机构审查委员会（HUM00133319）获得了本研究的伦理批准。 PATH研究由美国国立卫生研究院（National Institutes of Health）资助。研究结果将通过印刷，在线媒体，传播活动以及从业者和/或研究期刊进行传播。
试验注册号：NHLBI ClinicalTrials.gov标识符，NCT03189862。 2017年8月17日注册，https：//clinicaltrials.gov/ct2/show/NCT03189862。

BACKGROUND & AIMS: :Background: Children with intellectual disability are at risk for anxiety disorders involving intense physiological reactions and risky behavioral responses. Interventions have been identified in this field; however, assessment of underlying anxiety is limited and flawed.Method: We implemented a single-subject case study using differential reinforcement to treat dog phobia in a boy with intellectual disability. We recorded elopement and compliance with goals and measured physiological expressions of stress: galvanic skin response, heart rate variability, temperature, and latency to calm down.Results: After fifteen therapy sessions, the boy decreased elopement and noncompliance considerably and showed dramatic improvements in emotional self-regulation.Conclusions: Future research should examine the utility of including biosensing measures in clinical applications and the relationship between physiological measures of anxiety and traditional questionnaires. Children with intellectual disability at risk for anxiety disorders should be tracked longitudinally to examine the effect of interventions on social-emotional well-being and self-regulation.

背景与目标： ：背景：智障儿童有发生强烈的生理反应和危险的行为反应的焦虑症的风险。在这一领域已确定了干预措施；方法：我们实施了一项单项病例研究，使用差异增强技术治疗智障男孩的狗恐惧症。我们记录了私奔和达到目标的情况，并测量了压力的生理表达：皮肤电反应，心率变异性，温度和潜伏期的平静。结果：经过15次治疗，男孩显着减少了私奔和不依从行为，并在情绪上显示出显着改善结论：未来的研究应研究在临床应用中包括生物传感措施的实用性，以及焦虑的生理措施与传统问卷之间的关系。应纵向追踪有患焦虑症风险的智障儿童，以检查干预措施对社会情感幸福感和自我调节的影响。

BACKGROUND & AIMS: :Allogeneic hematopoietic stem cell transplantation (HSCT) remains a potentially curative and useful strategy in high-risk relapsing CLL. Minimal Residual Disease (MRD) assessment at 12 months post-HSCT is predictive of relapse. This phase 2 study aimed to achieve M12 MRD negativity (MRDneg) using MRD-driven immune-intervention (Md-PII) algorithm based on serial flow-cytometry blood MRD, involving cyclosporine tapering followed if failure by donor lymphocytes infusions. Patients had high-risk CLL according to 2006 EBMT consensus, in complete or partial response with lymphadenopathy < 5 cm and comorbidity score ≤ 2. Donors were HLA-matched sibling or matched unrelated (10/10). Forty-two enrolled patients with either 17p deletion (front-line, n=11; relapse n=16) or other high-risk relapse (n=15) received reduced intensity-conditioning regimen before HSCT and were submitted to Md-PII. M12-MRDneg status was achieved in 64% versus 14.2% before HSCT. With a median follow-up of 36 months (range, 19-53), 3-year overall survival, non-relapse mortality and cumulative incidence of relapse are 86.9% (95%CI, 70.8-94.4), 9.5% (95%CI, 3.7-23.4) and 29.6% (95%CI, 17.3-47.7). Incidence of 2-year limited and extensive chronic graft versus host disease (cGVHD) is 38% (95%CI, 23-53) and 23% (95%CI, 10-36) including 2 cases post Md-PII. Fifteen patients converted to MRDneg either after CsA withdrawal (n=12) or after cGVHD (n=3). As a time-dependent variable, MRDneg achievement at any time-point correlates with reduced relapse (HR=0.14 [0.04-0.53], p=0.004) and improvement of both progression free (HR=0.18 [0.06-0.6], p<0.005) and overall (HR: 0.18 [0.03-0.98], p=0.047) survival. These data highlight the value of MRD-driven immune-intervention to induce prompt MRD clearance in the therapy of CLL.

背景与目标： ：同种异体造血干细胞移植（HSCT）仍然是高危复发性CLL的潜在治愈和有用策略。 HSCT后12个月的最小残留疾病（MRD）评估可预测复发。这项2期研究旨在通过基于连续流式细胞术血液MRD的MRD驱动的免疫干预（Md-PII）算法来实现M12 MRD阴性（MRDneg），涉及环孢素渐缩，如果供体淋巴细胞输注失败。根据2006年EBMT共识，患者发生高危CLL，完全或部分缓解，淋巴结病<5 cm，合并症评分≤2。供体为HLA匹配兄弟姐妹或匹配的无关亲戚（10/10）。入组四十二例17p缺失（一线，n = 11；复发n = 16）或其他高危复发（n = 15）的患者在HSCT之前接受了降低强度的治疗方案，并接受了Md-PII治疗。 M12-MRDneg状态的获得率为64％，而HSCT前为14.2％。中位随访期为36个月（范围19-53），3年总生存率，非复发死亡率和累积复发率分别为86.9％（95％CI，70.8-94.4），9.5％（95％） CI为3.7-23.4）和29.6％（95％CI为17.3-47.7）。两年有限且广泛的慢性移植物抗宿主病（cGVHD）的发生率为38％（95％CI，23-53）和23％（95％CI，10-36），包括2例Md-PII后病例。 CsA停药后（n = 12）或cGVHD（n = 3）后有15例患者转变为MRDneg。作为随时间变化的变量，在任何时间点的MRDneg成就均与复发率降低（HR = 0.14 [0.04-0.53]，p = 0.004）和无进展进展的改善（HR = 0.18 [0.06-0.6]，p < 0.005）和总体生存率（HR：0.18 [0.03-0.98]，p = 0.047）。这些数据强调了MRD驱动的免疫干预在CLL治疗中诱导迅速清除MRD的价值。

BACKGROUND & AIMS: BACKGROUND:Connected health devices and applications (referred to hereafter as "SDApps" - Smart devices and applications) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. This article seeks to unpack this black box, and describes the process of elaboration of an intervention theory for healthy eating and physical activity SDApps. It includes a set of requirements relative to their impact on social health inequalities. METHODS:To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC) method. To this end, we developed a cumulative and iterative process combining scientific data from the literature with knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process, as follows: 1 - identifying the evidence base; 2 - developing the theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome. RESULTS:We produced an evidence-based theory according to the ToC model, based on scientific evidence and knowledge from experts and users. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals: Capacity, Opportunity, Motivation - Behavior (COM-B). Furthermore, the theory specifically integrates requirements relative to the impact on SHIs. CONCLUSIONS:This theory is an aid to SDAapp design and evaluation and it can be used to consider the question of the possible impact of SDApps on the increase in inequalities. Firstly, it enables developers to adopt a more overarching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered.

背景与目标： 背景技术：连接的健康设备和应用程序（以下称为“ SDApps”-智能设备和应用程序）被描绘为一种新的预防方法，并有望实现可访问性，有效性和个性化。存在许多具有很强内部效度的有效性评估（实验设计）。尽管效果确实有所不同，但尚未对这些设备使用的机制进行彻底研究。本文旨在解开黑匣子，并描述了针对健康饮食和体育锻炼SDApps的干预理论的详细阐述过程。它包括一组有关其对社会健康不平等影响的要求。
方法：为了建立这一理论，我们借鉴了理论驱动的方法，特别是基于变革理论（ToC）的方法。为此，我们开发了一个累积和迭代的过程，将文献中的科学数据与专家（研究人员和从业人员）以及患者或用户的知识相结合。这是一个三步过程，如下：1-确定证据基础； 2-通过设计干预和建立现实的期望来发展理论，包括在我们的案例中关于社会健康不平等（SHI）的具体工作； 3-建模过程和结果。
结果：我们根据ToC模型，基于科学证据和来自专家和用户的知识，产生了基于证据的理论。它提出了一种利用11种关键机制-理论域的因果路径，通过这些机制，可以将50种行为改变技术用于实现3个最终目标：能力，机会，动机-行为（COM-B）。此外，该理论专门整合了与对SHI的影响相关的要求。
结论：该理论有助于SDAapp的设计和评估，可用于考虑SDApps对不平等加剧的可能影响的问题。首先，它使开发人员能够采用更全面，更彻底的方法来支持行为更改，其次，它鼓励对现有SDApp进行全面且有贡献的评估。最后，它可以充分考虑健康不平等。

BACKGROUND & AIMS: AIMS:Prescribing medication is a complex process that, when done inappropriately, can lead to adverse drug events, resulting in patient harm and hospital admissions. Worldwide cost is estimated at 42 billion USD each year. Despite several efforts in the past years, medication-related harm has not declined. The aim was to determine whether a prescriber-focussed participatory action intervention, initiated by a multidisciplinary pharmacotherapy team, is able to reduce the number of in-hospital prescriptions containing ≥1 prescribing error (PE), by identifying and reducing challenges in appropriate prescribing. METHODS:A prospective single-centre before- and after study was conducted in an academic hospital in the Netherlands. Twelve clinical wards (medical, surgical, mixed and paediatric) were recruited. RESULTS:Overall, 321 patients with a total of 2978 prescriptions at baseline were compared with 201 patients with 2438 prescriptions postintervention. Of these, m456 prescriptions contained ≥1 PE (15.3%) at baseline and 357 prescriptions contained ≥1 PEs (14.6%) postintervention. PEs were determined in multidisciplinary consensus. On some study wards, a trend toward a decreasing number of PEs was observed. The intervention was associated with a nonsignificant difference in PEs (incidence rate ratio 0.96, 95% confidence interval 0.83-1.10), which was unaltered after correction. The most important identified challenges were insufficient knowledge beyond own expertise, unawareness of guidelines and a heavy workload. CONCLUSION:The tailored interventions developed with and implemented by stakeholders led to a statistically nonsignificant reduction in inappropriate in-hospital prescribing after a 6-month intervention period. Our prescriber-focussed participatory action intervention identified challenges in appropriate in-hospital prescribing on prescriber- and organizational level.

背景与目标： 目的：开药是一个复杂的过程，如果处理不当，可能会导致不良药物事件，从而导致患者伤害和住院。全世界每年的损失估计为420亿美元。尽管在过去几年中做出了一些努力，但与药物相关的危害并未减少。目的是确定由多学科药物治疗团队发起的针对处方者的参与式行动干预措施是否能够通过识别和减少适当处方中的挑战来减少住院处方中含有≥1个处方错误（PE）的处方数量。
方法：前瞻性单中心研究前后在荷兰的一家学术医院进行。招募了十二个临床病房（医学，外科，混合和儿科）。
结果：总体比较了基线时共321例2978处方的321例患者与干预后2 438处方的201例患者的比较。其中，m456处方在基线时包含≥1 PE（15.3％），而357份处方在干预后包含≥1 PE（14.6％）。 PE是在多学科共识中确定的。在某些研究病房中，观察到PE数量呈下降趋势。干预措施与PE的差异无统计学意义（发生率比0.96，95％置信区间0.83-1.10），校正后未改变。已确定的最重要挑战是，除了自身的专业知识之外，知识不足，对准则的意识不足以及工作量繁重。
结论：由利益相关者开发并实施的量身定制的干预措施在六个月的干预期后，导致院内不适当处方的统计上无统计学意义的减少。我们以处方者为中心的参与性行动干预措施，在处方者和组织层面确定了适当的医院内处方所面临的挑战。