• 【开发用于临床和研究用途的血管胎记数据库的机遇和障碍。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Sharma VK,Fraulin FO,Harrop AR,McPhalen DF
    BACKGROUND & AIMS: INTRODUCTION:Databases are useful tools in clinical settings. The authors review the benefits and challenges associated with the development and implementation of an efficient electronic database for the multidisciplinary Vascular Birthmark Clinic at the Alberta Children's Hospital, Calgary, Alberta. METHODS:The content and structure of the database were designed using the technical expertise of a data analyst from the Calgary Health Region. Relevant clinical and demographic data fields were included with the goal of documenting ongoing care of individual patients, and facilitating future epidemiological studies of this patient population. After completion of this database, 10 challenges encountered during development were retrospectively identified. Practical solutions for these challenges are presented. RESULTS:THE CHALLENGES IDENTIFIED DURING THE DATABASE DEVELOPMENT PROCESS INCLUDED: identification of relevant data fields; balancing simplicity and user-friendliness with complexity and comprehensive data storage; database expertise versus clinical expertise; software platform selection; linkage of data from the previous spreadsheet to a new data management system; ethics approval for the development of the database and its utilization for research studies; ensuring privacy and limited access to the database; integration of digital photographs into the database; adoption of the database by support staff in the clinic; and maintaining up-to-date entries in the database. CONCLUSIONS:There are several challenges involved in the development of a useful and efficient clinical database. Awareness of these potential obstacles, in advance, may simplify the development of clinical databases by others in various surgical settings.
    背景与目标: 简介:数据库是临床环境中的有用工具。作者回顾了为阿尔伯塔省卡尔加里市阿尔伯塔儿童医院的多学科血管性胎记诊所开发和实施高效的电子数据库所带来的收益和挑战。
    方法:数据库的内容和结构是使用来自卡尔加里卫生区的数据分析师的技术专长设计的。包括相关的临床和人口统计学数据字段,目的是记录对单个患者的持续护理,并促进对该患者人群的未来流行病学研究。该数据库完成后,回顾性地确定了开发过程中遇到的10个挑战。提出了应对这些挑战的实用解决方案。
    结果:在数据库开发过程中发现的挑战包括:识别相关数据字段;在简单性和用户友好性与复杂性和全面数据存储之间取得平衡;数据库专业知识与临床专业知识;软件平台选择;将以前的电子表格中的数据链接到新的数据管理系统;数据库开发及其研究研究的伦理批准;确保隐私和对数据库的有限访问;将数字照片集成到数据库中;诊所支持人员采用数据库;并维护数据库中的最新条目。
    结论:开发有用和高效的临床数据库涉及多个挑战。事先意识到这些潜在障碍可能会简化其他人在各种手术环境中临床数据库的开发。
  • 【对发展中国家蛋白质充足性的评估:质量至关重要。】 复制标题 收藏 收藏
    DOI:10.1017/S0007114512002577 复制DOI
    作者列表:Ghosh S,Suri D,Uauy R
    BACKGROUND & AIMS: :Dietary protein and amino acid requirement recommendations for normal "healthy" children and adults have varied considerably with 2007 FAO/WHO protein requirement estimates for children lower, but dietary essential AA requirements for adults more than doubled. Requirement estimates as presented do not account for common living conditions, which are prevalent in developing countries such as energy deficit, infection burden and added functional demands for protein and AAs. This study examined the effect of adjusting total dietary protein for quality and digestibility (PDCAAS) and of correcting current protein and AA requirements for the effect of infection and a mild energy deficit to estimate utilizable protein (total protein corrected for biological value and digestibility) and the risk/prevalence of protein inadequacy. The relationship between utilizable protein/prevalence of protein inadequacy and stunting across regions and countries was examined. Data sources (n = 116 countries) included FAO FBS (food supply), UNICEF (stunting prevalence), UNDP (GDP) and UNSTATS (IMR) and USDA nutrient tables. Statistical analyses included Pearson correlations, paired-sample/non-parametric t-tests and linear regression. Statistically significant differences were observed in risk/prevalence estimates of protein inadequacy using total protein and the current protein requirements versus utilizable protein and the adjusted protein requirements for all regions (p < 0·05). Total protein, utilizable protein, GDP per capita and total energy were each highly correlated with the prevalence of stunting. Energy, protein and utilizable protein availability were independently and negatively associated with stunting (p < 0·001), explaining 41 %, 34 % and 40 % of variation respectively. Controlling for energy, total protein was not a statistically significant factor but utilizable protein remained significant explaining~45 % of the variance (p = 0·017). Dietary utilizable protein provides a better index of population impact of risk/prevalence of protein inadequacy than crude protein intake. We conclude that the increased demand for protein due to infections and mild to moderate energy deficits, should be appropriately considered in assessing needs of populations where those conditions still prevail.
    背景与目标: :对于正常的“健康”儿童和成年人,饮食中蛋白质和氨基酸的需求建议相差很大,因为2007年FAO / WHO对儿童的蛋白质需求量估计值有所降低,但成年人的饮食中必需氨基酸的需求量增加了一倍以上。提出的需求估算并未考虑到发展中国家普遍存在的生活条件,例如能量不足,感染负担以及对蛋白质和氨基酸的额外功能需求。这项研究检查了调整饮食中总蛋白质的质量和消化率(PDCAAS)的效果,以及针对感染和轻度能量不足的影响校正当前蛋白质和AA需求以估算可利用蛋白质的影响(校正了总蛋白质的生物学价值和消化率),以及蛋白质不足的风险/患病率。研究了可利用的蛋白质/蛋白质不足的患病率与跨地区和国家发育迟缓之间的关系。数据来源(n = 116个国家)包括粮农组织FBS(食品供应),UNICEF(致病率),UNDP(GDP)和UNSTATS(IMR)和USDA营养表。统计分析包括Pearson相关性,成对样本/非参数t检验和线性回归。在所有区域中,使用总蛋白和当前蛋白需求量与可利用蛋白和调整后的蛋白需求量相比,蛋白不足的风险/患病率估计值中存在统计学上的显着差异(p <0·05)。总蛋白,可利用蛋白,人均GDP和总能量均与发育迟缓的发生率高度相关。能量,蛋白质和可利用的蛋白质利用率与发育迟缓独立相关并且呈负相关(p <0·001),分别解释了41%,34%和40%的变异。控制能量时,总蛋白质不是统计学上显着的因素,但是可利用的蛋白质仍然是重要的,解释了〜45%的方差(p = 0·017)。与粗蛋白摄入量相比,膳食可利用蛋白对蛋白质不足风险/流行的总体影响指数提供了更好的指标。我们得出的结论是,在评估那些情况仍然普遍存在的人群的需求时,应适当考虑由于感染和轻度至中度的能量不足导致的蛋白质需求增加。
  • 【在拉丁美洲国家之间,血清学检测作为幽门螺杆菌相关的癌前病变和胃癌的生物标志物的用途各不相同。】 复制标题 收藏 收藏
    DOI:10.1007/s10552-012-0106-8 复制DOI
    作者列表:Flores-Luna L,Camorlinga-Ponce M,Hernandez-Suarez G,Kasamatsu E,Martínez ME,Murillo R,Lazcano E,Torres J
    BACKGROUND & AIMS: PURPOSE:Currently, studies on serologic diagnosis of Helicobacter pylori-associated gastric cancer (GC) in Latin America are scarce. The aim of the present study was to evaluate the association between H. pylori serology tests in patients with early precancerous lesions or GC, when compared with non-atrophic gastritis in Colombia, Paraguay, and Mexico, three countries in Latin America with a high prevalence of H. pylori infection but contrasting rates of GC mortality. METHODS:Gastric biopsies and blood samples were obtained from patients attending the gastroenterology or oncology services of hospitals in the three participating countries. IgG antibodies against H. pylori whole-cell antigens and CagA were tested in 1,117 sera using an enzyme-linked immunoabsorbent assay. RESULTS:Positive and significant associations were shown for H. pylori seropositivity and preneoplastic lesions in Mexico (OR 2.0; 95 % CI 1.1-3.4) but not in Colombia (OR 1.2; 95 % CI 0.6-2.1) or Paraguay (OR 1.5; 95 % CI 0.6-3.2); no significant associations were shown for GC in any country. CagA seropositivity was associated with preneoplasic lesions in all three countries (ORs = 2.1, 3.0, and 3.1 for Mexico, Colombia, and Paraguay, respectively), and with GC only in Colombia (OR 4.3; 95 % CI 2.1-9.2). CONCLUSIONS:In countries of Latin America, the IgG CagA test might be a useful biomarker for patients with gastric preneoplastic lesions and for those at risk of developing gastric cancer.
    背景与目标: 目的:目前,拉丁美洲缺乏关于幽门螺杆菌相关性胃癌(GC)的血清学诊断的研究。本研究的目的是,与哥伦比亚,巴拉圭和墨西哥这三个高流行率国家中的非萎缩性胃炎相比,评估具有早期癌前病变或GC的幽门螺杆菌血清学检测之间的相关性幽门螺杆菌感染的发生率,但GC死亡率却相反。
    方法:从三个参与国医院的胃肠病学或肿瘤学服务的患者那里获取胃活检和血液样本。使用酶联免疫吸附试验在1117份血清中测试了针对幽门螺杆菌全细胞抗原和CagA的IgG抗体。
    结果:在墨西哥(OR 2.0; 95%CI 1.1-3.4)或哥伦比亚(OR 1.2; 95%CI 0.6-2.1)或巴拉圭(OR 1.5;墨西哥; OR);幽门螺杆菌血清阳性和肿瘤前病变的阳性和显着相关性。 95%CI 0.6-3.2);在任何国家/地区,GC均未显示任何重要关联。在所有三个国家中,CagA血清阳性与肿瘤前病变有关(墨西哥,哥伦比亚和巴拉圭的OR分别为2.1、3.0和3.1),仅在哥伦比亚与GC相关(OR 4.3; 95%CI 2.1-9.2)。
    结论:在拉丁美洲国家,IgG CagA检测对于胃癌前病变和有患胃癌风险的患者可能是有用的生物标志物。
  • 【发育中的大鼠少突胶质细胞中血栓烷A2受体信号转导的特征:核受体定位和髓鞘碱性蛋白表达的刺激。】 复制标题 收藏 收藏
    DOI:10.1002/jnr.21061 复制DOI
    作者列表:Ramamurthy S,Mir F,Gould RM,Le Breton GC
    BACKGROUND & AIMS: :The present work investigates the role of thromboxane A(2) (TXA(2)) receptors in the development of oligodendrocytes (OLGs). The results demonstrate that the proteins of the TXA(2) signaling pathway, i.e., cyclooxygenase (COX-1), TXA(2) synthase (TS), and TXA(2) receptor (TPR) are expressed in the developing rat brain during myelination. Furthermore, culture of OLG progenitor cells (OPCs) revealed that the expression levels of these proteins as well as TXA(2) synthesis increase during OLG maturation. Separate studies established that activation of TPRs by the agonist U46619 increases intracellular calcium in both OPCs and OLGs as visualized by digital fluorescence imaging. Immunocytochemical staining demonstrated that TPRs are localized in the plasma membrane and perinuclear compartments in OPCs. However, during OLG differentiation, TPRs shift their localization pattern and also become associated with the nuclear compartment. This shift to nuclear localization was confirmed by biochemical analysis in cultured cells and by immunocytochemical analysis in developing rat brain. Finally, it was found that U46619 activation of TPRs in maturing OLGs resulted in enhanced myelin basic protein (MBP) expression. Alternatively, inhibition of endogenous TPR signaling led to reduced MBP expression. Furthermore, TPR-mediated MBP expression was found to be associated with increased transcription from the MBP promoter using a MBP-luciferase reporter. Collectively, these findings suggest a novel TPR signaling pathway in OLGs and a potential role for this signaling during OLG maturation and myelin production.
    背景与目标: :本工作调查了血栓烷A(2)(TXA(2))受体在少突胶质细胞(OLG)发育中的作用。结果表明TXA(2)信号通路的蛋白质,即环氧合酶(COX-1),TXA(2)合酶(TS)和TXA(2)受体(TPR)在发育中的大鼠脑中表达髓鞘化。此外,OLG祖细胞(OPC)的培养显示,OLG成熟期间这些蛋白质的表达水平以及TXA(2)合成增加。单独的研究表明,通过数字荧光成像可以看到,激动剂U46619对TPR的激活会增加OPC和OLG中的细胞内钙含量。免疫细胞化学染色表明,TPR位于OPC的质膜和核周区室中。但是,在OLG分化过程中,TPR会改变其定位模式,并且也与核区室相关联。这种向核定位的转变已通过培养细胞的生化分析和发育中的大鼠脑部的免疫细胞化学分析得到证实。最后,发现成熟的OLG中TPR的U46619激活导致髓鞘碱性蛋白(MBP)表达增强。或者,抑制内源性TPR信号传导导致MBP表达降低。此外,使用MBP-荧光素酶报道基因,发现TPR介导的MBP表达与从MBP启动子的转录增加有关。总的来说,这些发现表明OLG中存在一种新型的TPR信号通路,并且在OLG成熟和髓鞘生成过程中该信号的潜在作用。
  • 【通过公共卫生与医学的结合解决全球卫生问题:发展华盛顿大学全球卫生部门。】 复制标题 收藏 收藏
    DOI:10.1097/01.ACM.0000238115.41885.c0 复制DOI
    作者列表:Stapleton FB,Wahl PW,Norris TE,Ramsey PG
    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兴趣是公共卫生学校和医学院的师生的共同特征。华盛顿大学以全球大学为基础的强大大学计划和社区计划为基础,创建了一个独特的全球卫生系,该系共同设在其公共卫生与社区医学学院和医学院之间。该部门的创建引起了整个大学和西雅图社区的极大热情,成为解决全球健康教育,研究和服务的新范式。在两所大学学校中设立新的全球卫生系,并在大学的许多全球卫生计划中找到适合该系的适当位置既带来了挑战,也带来了机遇。本文介绍了部门的目标,部门的创建过程以及预期要完成的工作。
  • 【ABCA3在发育中的肺和其他组织中的表达。】 复制标题 收藏 收藏
    DOI:10.1369/jhc.6A6962.2006 复制DOI
    作者列表:Stahlman MT,Besnard V,Wert SE,Weaver TE,Dingle S,Xu Y,von Zychlin K,Olson SJ,Whitsett JA
    BACKGROUND & AIMS: :ABCA3 is a member of the ATP-binding cassette (ABC) family of transport proteins and is required for perinatal respiratory adaptation. Monoclonal and polyclonal antibodies were generated against a recombinant human ABCA3 peptide and used to assess its expression in the developing lung and adult tissues. Immunostaining for ABCA3 was detected at highest levels in type II epithelial cells of the lung but was also noted in other organs including liver, stomach, kidney, adrenal, pancreas, trachea, and brain. In the fetal lung, ABCA3 staining and mRNA increased prior to birth. Like other surfactant protein genes, ABCA3 expression was induced by thyroid transcription factor-1 in vitro. ABCA3 was coexpressed with SP-B and proSP-C in type II epithelial cells. ABCA3 staining was detected surrounding large, intracellular organelles consistent with its association with lamellar bodies. In the human fetal lung, ABCA3 staining was not detected prior to 22-23 weeks of gestation, except in the presence of pulmonary inflammation. ABCA3 was detected in type II epithelial cells of the human lung from 28 weeks of gestation and thereafter. Postnatally, intense ABCA3 staining was observed in hyperplastic epithelial cells relining injured airways in infants with chronic lung disease. Localization and regulation of ABCA3 in the respiratory epithelium is consistent with its proposed role in surfactant homeostasis. The role of ABCA3 in extrapulmonary tissues and organs remains to be elucidated. This manuscript contains online supplemental material at (www.jhc.org). Please visit this article online to view these materials.
    背景与目标: :ABCA3是运输蛋白ATP结合盒(ABC)家族的成员,是围产期呼吸适应所必需的。产生了针对重组人ABCA3肽的单克隆和多克隆抗体,并用于评估其在发育中的肺和成人组织中的表达。在肺的II型上皮细胞中检测到最高水平的ABCA3免疫染色,但在其他器官(包括肝,胃,肾,肾上腺,胰腺,气管和脑)中也发现了免疫染色。在胎儿肺中,出生前ABCA3染色和mRNA增加。像其他表面活性剂蛋白基因一样,ABCA3表达在体外由甲状腺转录因子-1诱导。 ABCA3在II型上皮细胞中与SP-B和proSP-C共表达。在周围较大的细胞内细胞器中检测到ABCA3染色,这与它与层状体的结合相一致。在人胎肺中,除非存在肺部炎症,否则在妊娠22-23周之前未检测到ABCA3染色。从妊娠28周开始,在人肺的II型上皮细胞中检测到ABCA3。出生后,在患有慢性肺病的婴儿中,在衬砌受伤气道的增生上皮细胞中观察到了强烈的ABCA3染色。 ABCA3在呼吸道上皮细胞中的定位和调节与其在表面活性剂稳态中的拟议作用一致。 ABCA3在肺外组织和器官中的作用仍有待阐明。该手稿包含在线补充材料,网址为(www.jhc.org)。请在线访问本文以查看这些材料。
  • 【不良健康状况对进入和维持有酬就业的影响:欧洲国家的证据。】 复制标题 收藏 收藏
    DOI:10.1136/jech.2006.047456 复制DOI
    作者列表:Schuring M,Burdorf L,Kunst A,Mackenbach J
    BACKGROUND & AIMS: OBJECTIVES:To examine the effects of ill health on selection into paid employment in European countries. METHODS:Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis. RESULTS:An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level. CONCLUSION:In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.
    背景与目标: 目的:研究健康状况对欧洲国家选择有偿就业的影响。
    方法:欧洲共同体家庭小组的五次年度调查(1994-8年)用于选择两个人口:(1)4446名失业至少两年的受试者,其中1590(36%)受试者在下一年找到工作, (2)57 436名受雇至少2年的对象,其中6191(11%)个受雇者由于失业,(提前)退休或不得不照顾家庭而在第二年离开工作岗位。使用逻辑回归分析研究了感知不到的健康状况和慢性健康问题对就业转变的影响。
    结果:观察到健康与性别之间的相互作用,健康状况较差的女性(优势比(OR)0.4),健康状况较差的男性(OR 0.6)和女性(OR 0.6)的机会少于有良好状况的男性健康。健康状况差,教育水平低/中级的受试者失业或(早退休)的风险最高。照顾家庭仅受未婚妇女健康的影响。在大多数欧洲国家中,健康状况不佳或慢性健康问题预计会留下或变得失业,而且国民失业水平较低时,健康的影响更大。
    结论:在大多数欧洲国家,健康状况不佳的社会经济不平等是进入和维持有酬就业的重要决定因素。在实现健康公平的公共卫生措施中,将健康状况不佳的人纳入劳动力市场至关重要。
  • 【在11个国家提供咨询服务后,影响妇女选择激素结合避孕方法的因素:《选择》研究的亚分析结果。】 复制标题 收藏 收藏
    DOI:10.3109/13625187.2013.819077 复制DOI
    作者列表:Bitzer J,Cupanik V,Fait T,Gemzell-Danielsson K,Grob P,Oddens BJ,Pawelczyk L,Unzeitig V
    BACKGROUND & AIMS: OBJECTIVES:To investigate which characteristics of women and healthcare professionals (HCPs) were associated with changing to another combined hormonal contraceptive (CHC) method after contraceptive counselling. METHODS:CHOICE was a cross-sectional survey in which 18,787 women were counselled about combined hormonal contraceptives, during which their contraceptive methods preferred both prior to and after counselling were recorded. In this subanalysis, characteristics associated with changing the method after counselling were determined using logistic regression models. RESULTS:The probability of intending to change from the pill to another method was associated with being older; university-educated; being in a steady relationship; a prior unintended pregnancy; a younger HCP or one who recommended methods other than the pill. Changing to the patch was associated with a female HCP or a HCP who recommended the patch or an injectable. Changing to the ring was associated with being over 21 years; university-educated; being in a relationship; previous hormonal method use; and counselling by a female HCP, a HCP < 60 years old, or a HCP who recommended the ring or an implant. The country of residence influenced these changes in a complex pattern. CONCLUSIONS:Women's choice of CHC methods after contraceptive counselling are influenced by their age, educational background, relationship status, prior unplanned pregnancies and country of residence, as well as age, gender and preferences of their HCP.
    背景与目标: 目的:调查在避孕咨询后,女性和医护人员(HCP)的哪些特征与改用另一种联合激素避孕(CHC)方法有关。
    方法:选择是一项横断面调查,其中向18,787名妇女提供了有关联合激素避孕药的咨询,在此期间,记录了她们在咨询之前和之后首选的避孕方法。在此子分析中,使用逻辑回归模型确定与咨询后更改方法有关的特征。
    结果:打算从药丸换成另一种方法的可能性与年纪大有关。受过大学教育;保持稳定的关系;先前的意外怀孕;较年轻的HCP或建议使用除药丸以外的方法的人。更换贴剂与女性HCP或推荐贴剂或注射剂的HCP有关。更换戒指的年龄超过21岁。受过大学教育;处于恋爱关系中;以前使用过的荷尔蒙方法;并由女性HCP,小于60岁的HCP或推荐环或植入物的HCP进行咨询。居住国以复杂的方式影响了这些变化。
    结论:避孕咨询后,妇女选择慢性丙型肝炎的方法受到其年龄,教育背景,人际关系,先前计划外的怀孕和居住国家,年龄,性别和他们的HCP偏好的影响。
  • 【行动中学习:通过行动学习来开发安全改进功能。】 复制标题 收藏 收藏
    DOI:10.1016/j.nedt.2013.07.008 复制DOI
    作者列表:Christiansen A,Prescott T,Ball J
    BACKGROUND & AIMS: :Patient safety is one of the greatest challenges facing health care today and nurses are well placed to find opportunities for enhancing care and making it safer. Nurse education has an important role to play in ensuring future professions have capabilities and confidence to meet this challenge however this requires new pedagogies in nurse education. This paper reports on an initiative to develop the safety improvement and leadership capabilities of final year nursing students using Action Learning to support students to undertake a safety improvement project in the clinical setting. A qualitative, interpretive research approach was used to explore students' experiences of participation in Action Learning. 52 nursing students from a UK University participated in the study. Student accounts of their experiences were generated through focus group and individual interviews and data were subject to thematic analysis. Findings are discussed in relation to three categories including "creating an enabling environment", "learning through action and reflection" and "the emergence of safety improvement and leadership practices." The study findings provide valuable insights into how AL processes can engender personal leadership capabilities and support students to make a valuable contribution to safer care practices, both as students and as future health care professionals.
    背景与目标: :患者的安全性是当今医疗保健面临的最大挑战之一,护士已准备好寻找机会来加强护理并使其更加安全。护士教育在确保未来的职业具有应对这一挑战的能力和信心方面可发挥重要作用,但这需要在护士教育中采用新的教学法。本文报告了一项旨在通过行动学习来发展最终护理学生的安全改进和领导能力的倡议,以支持学生在临床环境中开展安全改进项目。使用定性,解释性研究方法来探索学生参与行动学习的经验。来自英国大学的52名护理专业学生参加了这项研究。通过专题小组对学生的经历进行描述,并通过专题访谈对个人访谈和数据进行分析。讨论了与三个类别有关的发现,包括“创造有利的环境”,“通过行动和反思进行学习”以及“安全改进和领导实践的出现”。研究结果为AL过程如何增强个人领导能力和支持学生(无论是作为学生还是将来的医疗保健专业人员)对更安全的护理实践做出了宝贵的贡献提供了宝贵的见解。
  • 【世卫组织欧洲区域各国间儿童耐多药结核病接触者的管理:对当前做法的调查。】 复制标题 收藏 收藏
    DOI:10.5588/ijtld.16.0949 复制DOI
    作者列表:Turkova A,Tebruegge M,Brinkmann F,Tsolia M,Mouchet F,Kampmann B,Seddon JA
    BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).
    背景与目标: :世界卫生组织欧洲区域是世界上耐多药结核病(MDR-TB)发病率最高的国家之一,每年导致许多弱势儿童被暴露。耐多药结核病暴露后进行预防性治疗的证据有限,目前的指导意见相互矛盾。进行了基于互联网的调查,以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛查和决策有关的做法变化很大。刚刚超过一半的人为患有耐多药结核病的儿童提供了预防性治疗;与规定相关的唯一特征是欧盟内部的惯例(调整后的OR 4.07,95%CI 1.33-12.5)。
  • 11 Telemedicine support for the developing world. 复制标题 收藏 收藏

    【对发展中国家的远程医疗支持。】 复制标题 收藏 收藏
    DOI:10.1258/jtt.2008.003001 复制DOI
    作者列表:Wootton R
    BACKGROUND & AIMS: :Telemedicine has been used for some years in the industrialized world, albeit with rather mixed success. There is also a considerable literature on the potential use of telemedicine for the developing world. However, there are few reports of the actual use of telemedicine there. A review identified five telemedicine networks providing second opinions; each network had been in operation for over five years. Although they have different aims and methods of operation, they exhibit some common features. In particular, none of them appear to be dealing with markedly increasing referral rates. Rough calculations suggest that only about 0.1% of the potential telemedicine demand from the developing world is being met. Possible reasons include the referrers being too busy and a perceived loss of control. If this analysis is correct, then the right strategy for future telemedicine in developing countries will be to concentrate on the construction of within-country networks that demonstrably alter health outcomes, can be shown to be cost-effective and sustainable, and will provide a model for other countries to copy.
    背景与目标: :Telemedicine在工业化世界中已经使用了几年,尽管取得了不同的成功。关于远程医疗在发展中国家的潜在用途,也有大量文献。但是,那里很少有关于远程医疗实际使用的报道。审查确定了五个提供第二意见的远程医疗网络;每个网络已经运行了五年以上。尽管它们具有不同的目标和操作方法,但它们具有一些共同的特征。特别是,它们似乎都没有处理引荐率显着提高的问题。粗略的计算表明,仅满足了发展中国家潜在的远程医疗需求的0.1%。可能的原因包括引荐来源人太忙和感觉失控。如果这一分析是正确的,那么发展中国家未来远程医疗的正确策略将是集中于国家内部网络的建设,这些网络将明显改变健康状况,可以证明其具有成本效益和可持续性,并将提供一个模型。供其他国家复制。
  • 【向其他国家学习:卫生政策的随时待命工具。】 复制标题 收藏 收藏
    DOI:10.1258/jhsrp.2007.007146 复制DOI
    作者列表:Nolte E,Ettelt S,Thomson S,Mays N
    BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.
    背景与目标: :卫生部认识到其他国家/地区强大的卫生系统信息可以为英国国家卫生服务局提供宝贵的经验,因此在2005年委托一个学术团队提供“国际医疗比较的待命服务”。这种新颖的方法来指导政策并回顾前两年的经验。它说明了卫生系统比较分析中有据可查的挑战。一个重要的问题是了解卫生系统的背景情况,以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严格性之间的潜在紧张关系,以及需要及时分析以告知卫生部迅速变化的政策议程的挑战。所涉主题的多样性和性质以及快速的周转时间,意味着该基金必须认真权衡严格性和及时性,以确保报告的价值和相关性。强大的研究基础与国家专家的国际网络相联系,促进了以相对较低的成本提供高质量的分析。但是,只有为其他基础研究提供了范围,这样的安排才能维持下去。目前尚无关于英格兰对卫生保健政策制定影响的正式评估。这些知识对于开发其他地方的类似资源至关重要。
  • 【小鼠正在发育的肺中的Hoxa-5:细胞特异性表达和视黄酸调节。】 复制标题 收藏 收藏
    DOI:10.1152/ajplung.2000.279.5.L863 复制DOI
    作者列表:Kim C,Nielsen HC
    BACKGROUND & AIMS: :Hoxa-5 is a homeobox gene that is highly expressed in the developing mouse lung. However, little is known about the molecular mechanisms controlling expression. We characterized the ontogeny of Hoxa-5 gene and protein expressions during lung development and then studied the cell-specific effects of retinoic acid (RA) on Hoxa-5 mRNA in fetal lung fibroblasts and MLE-12 mouse lung epithelial cells. Strong but constant Hoxa-5 gene and protein expressions were detected from mouse lung on embryonic day 13.5 to postnatal day 2. At baseline, the gene was strongly expressed in the fibroblasts of day 17.5 fetal mouse lungs. A very weak but reproducible expression was present in the MLE-12 cells. RA stimulated gene expression in both cell types in a time- and dose-dependent manner. Peak expression occurred much later in the MLE-12 cells compared with that in fibroblasts. Cycloheximide and actinomycin D treatment studies suggested that the differences in RA effect on each cell type may involve the presence of a repressor that can be overcome by RA.
    背景与目标: :Hoxa-5是一个同源盒基因,在发育中的小鼠肺中高度表达。但是,关于控制表达的分子机制知之甚少。我们表征了肺发育过程中Hoxa-5基因和蛋白质表达的存在,然后研究了维甲酸(RA)对胎儿肺成纤维细胞和MLE-12小鼠肺上皮细胞中Hoxa-5 mRNA的细胞特异性作用。在胚胎第13.5天至出生后第2天从小鼠肺中检测到强而恒定的Hoxa-5基因和蛋白质表达。在基线时,该基因在17.5天胎儿小鼠肺的成纤维细胞中强烈表达。 MLE-12细胞中存在非常弱但可重现的表达。 RA以时间和剂量依赖性方式刺激两种细胞类型中的基因表达。与成纤维细胞相比,MLE-12细胞的峰值表达要晚得多。环己酰亚胺和放线菌素D的治疗研究表明,RA对每种细胞类型的作用差异可能涉及存在可以被RA克服的阻遏物。
  • 【13价肺炎球菌结合疫苗在婴儿和儿童中的安全性:9个国家/地区的13项临床试验的荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1016/j.vaccine.2013.08.025 复制DOI
    作者列表:Thompson A,Gurtman A,Patterson S,Juergens C,Laudat F,Emini EA,Gruber WC,Scott DA
    BACKGROUND & AIMS: BACKGROUND:Meta-analyses enable summarization and interpretation of data across clinical trials. When applied to safety data they allow for detection of rare events. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was approved in multiple countries worldwide for routine immunization of infants and young children. This meta-analysis was conducted to identify potentially clinically important rare safety events associated with PCV13. OBJECTIVE:To summarize the safety of PCV13 compared with 7-valent pneumococcal conjugate vaccine (PCV7) administered to infants and toddlers. METHODS:A meta-analysis was performed of integrated safety data from 13 infant studies (PCV13 n=4729 and PCV7 n=2760) conducted in 9 North American, European, and Asian countries. Local reactions at the vaccine injection site and systemic events were collected for 4-7 days after each dose into electronic diaries. Adverse events (AEs) were collected after each vaccination. RESULTS:Overall, rates of local reactions after any dose of the infant series were similar between PCV13 and PCV7 groups: tenderness (46.7% vs 44.8%, respectively); swelling (28.5% vs 26.9%); and redness (36.4% vs 33.9%). After the toddler dose, tenderness was significantly higher among PCV7 subjects than PCV13 subjects (54.4% vs 48.8%; P=0.005). Frequencies of fever (≥38°C) were similar in both groups and mostly mild (≤39°C); incidence of moderate fever (>39°C to ≤40°C) with PCV13 was ≤2.8% after any infant dose and 5.0% after the toddler dose, compared with ≤2.6% and 7.3%, respectively, with PCV7. Fever >40°C was uncommon in both groups. Frequencies of decreased appetite, irritability, and sleep disturbances were similar in both groups. AEs were the types of conditions and symptoms expected in infants and children, and clinically significant differences between vaccine groups were not observed. CONCLUSION:PCV13 has a favorable safety profile similar to that of PCV7, a vaccine for which there is >10 years clinical experience.
    背景与目标: 背景:元分析可以汇总和解释整个临床试验中的数据。当应用于安全数据时,它们允许检测罕见事件。最近,一种13价肺炎球菌结合疫苗(PCV13)已在全球多个国家/地区批准用于婴儿和幼儿的常规免疫。进行这项荟萃分析,以鉴定与PCV13相关的潜在的临床上重要的罕见安全事件。
    目的:总结与婴幼儿使用的7价肺炎球菌结合疫苗(PCV7)相比,PCV13的安全性。
    方法:对9个北美,欧洲和亚洲国家进行的13项婴儿研究(PCV13 n = 4729和PCV7 n = 2760)的综合安全性数据进行了荟萃分析。每次注射疫苗后4-7天,将疫苗注射部位的局部反应和全身性事件收集到电子日记中。每次疫苗接种后收集不良事件(AE)。
    结果:总的来说,在PCV13和PCV7组中,任何剂量的婴儿系列后的局部反应率相似:压痛(分别为46.7%和44.8%);肿胀(28.5%对26.9%);和发红(36.4%比33.9%)。幼儿服药后,PCV7受试者的压痛明显高于PCV13受试者(54.4%比48.8%; P = 0.005)。两组的发烧频率(≥38°C)相似,且多数为轻度(≤39°C)。在任何婴儿剂量下,PCV13发生中度发烧(> 39°C到≤40°C)的发生率≤2.8%,在幼儿剂量后为5.0%,而PCV7分别为≤2.6%和7.3%。两组中发烧> 40°C的情况很少见。两组食欲减退,烦躁不安和睡眠障碍的频率相似。不良事件是婴儿和儿童中预期的疾病和症状类型,未观察到疫苗组之间的临床显着差异。
    结论:PCV13具有与PCV7类似的良好安全性,后者具有10年以上的临床经验。
  • 【综述文章:小肠细菌过度生长-患病率,临床特征,当前和发展中的诊断测试以及治疗方法。】 复制标题 收藏 收藏
    DOI:10.1111/apt.12456 复制DOI
    作者列表:Grace E,Shaw C,Whelan K,Andreyev HJ
    BACKGROUND & AIMS: BACKGROUND:The symptoms and signs of small intestinal bacterial overgrowth (SIBO) are often identical to a variety of diseases and can lead to diagnostic confusion. AIMS:To review the diagnostic options for SIBO and present new investigative options for the condition. METHODS:A literature search was performed on MEDLINE, EMBASE and Web of Science for English articles and abstracts. Search terms included free text words and combinations of the following terms 'small intestinal bacterial overgrowth', 'small bowel bacterial overgrowth', 'diagnostic tests', 'treatment', 'antibiotics', 'probiotics', 'metabonomics', 'proton nuclear magnetic resonance spectroscopy', 'electronic nose' and 'field asymmetric ion mobility spectrometry'. RESULTS:All of the available methods to test for SIBO have inherent limitations and no 'gold-standard' diagnostic test for the condition exists. Accurate diagnosis of SIBO requires identification of bacterial species growing inappropriately within the small intestine and symptom response to antibiotics. Proton nuclear magnetic resonance spectroscopy, electronic nose technology and/or field asymmetric ion mobility spectrometry may represent better investigative options for the condition. CONCLUSIONS:Novel diagnostic options are needed to supplement or replace available tests.
    背景与目标: 背景:小肠细菌过度生长(SIBO)的症状和体征通常与多种疾病相同,并可能导致诊断混乱。
    目的:审查SIBO的诊断方案并提出针对该病的新研究方案。
    方法:在MEDLINE,EMBASE和Web of Science上对英文文章和摘要进行文献检索。搜索词包括自由文本单词和以下术语的组合:“小肠细菌过度生长”,“小肠细菌过度生长”,“诊断测试”,“治疗”,“抗生素”,“益生菌”,“代谢组学”,“质子核”磁共振波谱”,“电子鼻”和“场非对称离子迁移谱”。
    结果:所有可用于SIBO检验的方法都有其固有的局限性,并且不存在针对这种情况的“金标准”诊断测试。 SIBO的准确诊断需要鉴定在小肠内不适当生长的细菌种类以及对抗生素的症状反应。质子核磁共振波谱,电子鼻技术和/或场不对称离子迁移谱法可能代表对该病的更好的研究选择。
    结论:需要新颖的诊断选项来补充或替换可用的测试。

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