With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 17...With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022.The participants were randomly assigned to an observation group and a control group.The observation group received pharmaceutical intervention,whereas the control group did not.The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population.The results revealed that after pharmaceutical intervention,there were no significant differences in medication adherence,medication appropriateness index(MAI),quantity of medicine,and potentially inappropriate medication(PIM)in the control group compared to before the intervention(P>0.05).However,the observation group showed significant improvement(P<0.05).The proportion of patients with good adherence increased from 57%to 78%,and the percentage of patients with MAI scores over 10 decreased from 60%to 40%.Moreover,there was a reduction in the number of medications prescribed,with only 47%of patients receiving more than five different types compared to the initial rate of 64%.Additionally,the occurrence of PIM declined from an initial rate of 64%to just 44%,surpassing that observed in the control group.Therefore,the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients,mitigate the risk of PIM,and promote rational medicine utilization.展开更多
Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are ...Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.展开更多
Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral com...Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral communication.展开更多
AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 7...AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 736 consecutive patients (415males, 321 females; mean age 43.6±16.6 years)undergoing colonoscopy during October 2001-March2002 Were prospectively enrolled in the study. The 2000ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered'generally indicated'; it was 'generally not indicated' for20%, and it was 'not listed' for 16% in the guidelines.The diagnostic yield of colonoscopy was highest for the 'generally indicated' (38%) followed by 'not listed'(13%) and 'generally not indicated' (5%) categories.In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was 'generally indicated' (odds ratio=12.3) and referrals by gastroenterologist (odds ratio = 1.9).CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications 'not listed' in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.展开更多
AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI...AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI) endoscopy [381 for esophagogastroduodenoscopy(EGD) and 408 for colonoscopy] were prospectively enrolled in the study.The American Society for Gastrointestinal Endoscopy(ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic f indings.RESULTS:The overall inappropriate rate was 13.3%.The indications for EGD and colonoscopy were,respectively,appropriate in 82.7% and 82.6% of the exams,uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%.The diagnostic yield was signif icant higher forEGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate(EGD:36.6% vs 36.4% vs 11.4%,P = 0.004;Colonoscopy:24.3% vs 20.0% vs 3.3%,P = 0.001).Of the 25 malignant lesions detected,all but one was detected in exams judged appropriate or uncertain.CONCLUSION:This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations,namely in detecting neoplastic lesions.It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.展开更多
<strong>Background:</strong> Computed tomography (CT) Scan is the imaging of choice for the diagnosis of sino nasal (SN) pathologies in sub-Saharan African setting. However, it is often requested by non ex...<strong>Background:</strong> Computed tomography (CT) Scan is the imaging of choice for the diagnosis of sino nasal (SN) pathologies in sub-Saharan African setting. However, it is often requested by non experienced practitioners. We aimed to describe the utility and the appropriateness of CT Scan request forms and results in the diagnosis of SN pathologies. <strong>Method:</strong> We conducted a retrospective cross-sectional study in four health facilities in Yaoundé, Cameroun, from October 2018 to September 2019. All patients to whom SN CT Scan was performed were called for an appointment. After informed consent, data on the appropriateness and conformity of the request form were collected and compared to the guidelines of the French society of radiology. CT Scan results were also collected and the quality of the report was evaluated. <strong>Results:</strong> A total of 206 SN CT Scan request forms and reports were included, with a mean patient age of 37.7 ± 16.1 years. The request form was conformed to guidelines in 8.3% of cases and was found appropriate in 62.6% of cases. No CT Scan report had all the items required, and 159 (77.2%) reports were useful. The most common diagnosis in patients with abnormal results was chronic sinusitis (49.5%) and SN polyp or polyposis (19.4%). <strong>Conclusion:</strong> Most of SN CT Scan requested were appropriate and useful. However, the conformity of request forms and reports to the guidelines is low. Suggesting the need for capacity building for the diagnosis of SN pathologies especially for non specialists like general practitioners and nurses.展开更多
Background: Preventive care of diabetic foot and eye complications is essential. However, data on the prevalence of and factors associated with screening of angiopathic complications in ambulatory patients with diabet...Background: Preventive care of diabetic foot and eye complications is essential. However, data on the prevalence of and factors associated with screening of angiopathic complications in ambulatory patients with diabetes are very limited in Switzerland. We aimed to fill this gap of knowledge. Methods: Cross-sectional data on recommended preventive care using RAND’s criteria in a random sample of patients aged 50-80 years in 2005-2006. Participants were recruited from 4 Swiss university primary care settings (in Lausanne, Geneva, Zürich and Basel). Scores for general preventive care in patients with and without diabetes were calculated by using generalized estimating equation binomial models. Multivariate regression models were used to identify determinants of appropriateness of angiopathic complications prevention. The main outcome measure was appropriateness of screening for angiopathic complications based on the 2005 American Diabetes Association recommendations corresponding to the period of data collection. Results: Among the 1002 patients aged 50 - 80 years, 292 (29.1%) had diabetes (101/292 [34.6%] female, mean BMI 30.7 [SD 5.7]). Fifty-nine percent had appropriate preventive foot care and 55.8% had appropriate preventive eye care. Only 34.6% had appropriate preventive care of both foot and eye. No differences in aggregate scores for general preventive care in patients with and without diabetes were found (67.5% vs. 69.1%, p value 0.39). In multivariate model, obesity was negatively (OR = 0.28, 0.15 - 0.53) and hyperlipidemia positively (OR = 2.29, 1.20 - 4.38) associated with appropriate eye preventive care and with appropriate combined foot and eye preventive care (OR = 0.35, 0.18 - 0.70 for obesity and OR = 2.82, 1.24 - 6.40 for hyperlipidemia). Conclusions: Preventive care of diabetic angiopathic complications is low among ambulatory patients despite universal health care coverage. Particular attention should be paid to obese patients with diabetes.展开更多
Purpose: This study aimed to develop teaching materials to prevent the dangers of ablution and bathing infants, based on the dangerous experiences of mothers and family members, and examine their appropriateness. Meth...Purpose: This study aimed to develop teaching materials to prevent the dangers of ablution and bathing infants, based on the dangerous experiences of mothers and family members, and examine their appropriateness. Methods: A total of 20 midwives and public health nurses were selected as participants. Teaching materials and anonymous self-administered questionnaires were distributed, and the participants were asked to view the teaching materials and fill in the questionnaires. Retrieval was done by mail. The teaching materials included digital content, such as videos, sounds, and characters, which incorporated dangerous situations, preventions, and innovations in ablution and bathing procedures. The analysis was conducted by simple tabulation for each survey item. The free description was coded to preserve anonymity. This study was conducted with the approval of the Research Ethics Review Board of the authors’ affiliated university. Results: The teaching materials were found to be appropriate in terms of suitability to purpose, degree of difficulty of content, ease of viewing the videos, validity of time, appropriateness of expression, and usability. Conclusions: Ablution teaching materials that are used at the present time do not focus on dangers, and to date, no resources on bathing have been used as teaching materials. The created teaching materials in this study can be viewed multiple times, and mothers and family members who are unfamiliar with ablution and bathing can acquire knowledge regarding dangers and danger prevention. The addition of specific preventive measures and countermeasures for the occurrence of danger, along with practice, would result in the development of further appropriate teaching materials to reduce danger and alleviate anxiety.展开更多
The Politeness Principle proposed by Leech complements Grice'Cooperative Principle to a certain extent in explaining the indirectness of language. However,the nature of politeness is its relativity.Determined by v...The Politeness Principle proposed by Leech complements Grice'Cooperative Principle to a certain extent in explaining the indirectness of language. However,the nature of politeness is its relativity.Determined by various factors such as social and cultural ones,the appropriateness of politeness at utterance level is affected by the appropriateness of the pragmatic distance between the participants. Different from the interpersonal relationships,pragmatic distance is calculated and determined in the process of communication varying with the variation of the communicative factors. Pragmatic distance is dynamic and can be maintained and altered by participants by using certain linguistic expressions to achieve the appropriateness of politeness in communication.展开更多
Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice;2) To assess appropriateness colonoscopy using EPAGE criteria;3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred...Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice;2) To assess appropriateness colonoscopy using EPAGE criteria;3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%;27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years;p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.展开更多
In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of ...In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff’s feedback on residents’ behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists’ APDs through nursing staff’s monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff’s perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff’s positive participation in PUM intervention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.展开更多
Background: Proton pump inhibitors (PPIs) are drugs that reduce the production of acid in the stomach. Recently, the use of PPI has been increasing among communities, whether with or without prescription. As a part of...Background: Proton pump inhibitors (PPIs) are drugs that reduce the production of acid in the stomach. Recently, the use of PPI has been increasing among communities, whether with or without prescription. As a part of the healthcare team, the pharmacist should not only dispense medications but also ensure the appropriate use of these medications. Studies conducted within 16 countries showed substantial variation in the appropriateness of the use of PPI drugs. Aim: To evaluate the appropriateness of PPIs use in Sharjah, UAE based on surveys answered by pharmacists, physicians, and patients. Methods: A cross-sectional survey study was conducted on December 2017 at Sharjah, UAE as an example of information obtained from the Middle East. Two different surveys were conducted on physicians and pharmacists. Both Physicians and Pharmacists were chosen randomly from Yellow Pages. The results obtained from both studies were used to develop a patient’s survey, which was distributed among University of Sharjah students, their families and random people at Shopping Malls and Clinics. Results: The results obtained from the patients’ survey showed that ~39% of PPI users from the region of Sharjah are 25 - 44 years old. Approximately 79% are using PPI according to physicians’ prescriptions. Prescriptions’ duration is varied between 1 month (39%) and 6 months (22%), where 52% of PPI users ask their physicians to prescribe PPIs when needed. Suggested reasons for the use of PPI included inappropriate food habits (52%), use of other medications (16%) or bacterial infection (13%). Around 52% of the patients did not receive any recommendations regarding the deprescribing of PPIs. According to the pharmacists’ surveys, an average sale of 5 - 10 PPI packages is reported per day, and around 50% are sold without a prescription. Most pharmacists were not fully aware of the health conditions and side effects of PPI drugs. On the other hand, physicians’ surveys showed that PPIs were mainly prescribed in the case of GERD and ulcer and for a maximum of 2 - 4 weeks. Approximately 75% of physicians recommend changing regimen by reducing the dose and stopping in case of chronic use of PPIs. Conclusion: The results from this survey study indicated that even though most PPI consumers at Sharjah, UAE are well aware of the use of PPI drugs and they follow the instructions given by the Physicians’, there is some discrepancy in the information obtained by the physicians, pharmacists, and patients. The reason for this discrepancy may be attributed to the missing role of the pharmacists which is currently just dispensing the medications without appropriate counseling. Thus the appropriate role of the pharmacists should be implemented according to the known international guidelines.展开更多
Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination...Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion.This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence,aiming to provide general guidance on appropriate imaging examination selection,comprehensive and accurate imaging assessment for early orthodontic treatment patients.展开更多
Aim: Myasthenia gravis (MG) is a rare and heterogeneous disease for which there is no generally accepted standard of care. Thus, it is critical that MG experts develop consensus guidelines based on their practice and ...Aim: Myasthenia gravis (MG) is a rare and heterogeneous disease for which there is no generally accepted standard of care. Thus, it is critical that MG experts develop consensus guidelines based on their practice and disease management to assist clinicians and provide advice for insurance companies, health organizations and institutional review boards. Methods: An international treatment guidance was developed based on national guidelines established in the US, Denmark, Norway, Germany, Japan, Netherlands, United Kingdom and Europe. The RAND/UCLA appropriateness method (RAM) was applied to reach consensus among 15 worldly renowned experts and experienced clinicians. Results: This paper introduced the RAM procedure with its principles and applications and conducted a brief review of the resulting 2016 international consensus guidance for MG in comparison to clinical experience and management of Chinese MG patients. Conclusion: The 2016 international consensus guidance is a major contribution to the treatment and management of MG, providing an up-to-date expert consensus to assist clinicians around the world, especially those with limited experience and/or practice in countries/regions that have limited resources to develop local treatment guidelines. It is also an important contribution showing how RAM can help to develop consensus guidance for treatment of rare diseases based on scientific findings and expert experience.展开更多
Currently,the number of patients with myopia is increasing rapidly across the globe.Traditional Chinese medicine(TCM),with its long history and rich experience,has shown promise in effectively managing and treating th...Currently,the number of patients with myopia is increasing rapidly across the globe.Traditional Chinese medicine(TCM),with its long history and rich experience,has shown promise in effectively managing and treating this condition.Nevertheless,considering the vast amount of research that is currently being conducted,focusing on the utilization of TCM in the management of myopia,there is an urgent requirement for a thorough and comprehensive review.The review would serve to clarify the practical applications of TCM within this specific field,and it would also aim to elucidate the underlying mechanisms that are at play,providing a deeper understanding of how TCM principles can be effectively integrated into modern medical practices.Here,some modern medical pathogenesis of myopia and appropriate TCM techniques studies are summarized in the prevention and treatment of myopia.Further,we discussed the potential mechanisms and the future research directions of TCM against myopia.Identifying these mechanisms is crucial for understanding how TCM can be effectively utilized in this context.The combination of various TCM methods or the combination of traditional Chinese and Western medicine is of great significance for the prevention and control of myopia in the future.展开更多
Objective: This study aims to analyze the distribution of positive human papillomavirus (HPV) infections among women of appropriate age in Beiliu City during cervical cancer screening in 2024, providing data support f...Objective: This study aims to analyze the distribution of positive human papillomavirus (HPV) infections among women of appropriate age in Beiliu City during cervical cancer screening in 2024, providing data support for subsequent public health interventions. Methods: A retrospective analysis was conducted on the HPV test results from January 1, 2024, to November 30, 2024, at Beiliu Maternal and Child Health Hospital. We statistically analyzed the positive rates of different HPV genotypes and the co-infection status of multiple genotypes. Results: A total of 7558 individuals were tested, with 1103 positive cases identified, resulting in a positivity rate of 14.59%. Among these, HPV type 52 had the highest positive rate, accounting for 18.47%. The co-infection analysis showed that there were 788 cases with single genotype positivity, 236 with double genotype positivity, and 58 with triple genotype positivity, while cases with multiple genotypes simultaneously positive were relatively rare. Conclusion: The HPV infection rate among women of appropriate age in Beiliu City is relatively high, especially for high-risk HPV types. To reduce the future incidence of cervical cancer, it is recommended to enhance health education and vaccination efforts for this population.展开更多
The purpose of this study was to explore the application of TCM-appropriate technology in neurogenic bladder rehabilitation nursing.Firstly,the background and contents of the study were introduced.Then,it summarizes t...The purpose of this study was to explore the application of TCM-appropriate technology in neurogenic bladder rehabilitation nursing.Firstly,the background and contents of the study were introduced.Then,it summarizes the definition and development of TCM-appropriate technology and expounds the main therapy and application of TCM-appropriate technology in the rehabilitation nursing field.Besides,the pathophysiological characteristics,rehabilitation nursing measures,and rehabilitation difficulties of the neurogenic bladder are described.Then,the application method,effect and prospect of TCM-suitable technology in rehabilitation nursing of neurogenic bladder are described.In addition,the object,method,result analysis,and conclusion of the experimental study are introduced,the main results of this study are summarized,and the future research direction is prospected.In summary,this study aims to provide effective TCM-appropriate technology for neurogenic bladder rehabilitation nursing and provide a reference for clinical practice and theoretical research in related fields.展开更多
Social behaviors are crucial for gregarious animals,including humans.In order to exhibit appropriate behaviors in a complex social context,such as mating,aggression,avoidance,and cooperation,individuals need to rememb...Social behaviors are crucial for gregarious animals,including humans.In order to exhibit appropriate behaviors in a complex social context,such as mating,aggression,avoidance,and cooperation,individuals need to remember their previous experiences with other members and accurately recognize them when they meet again.This ability is called“social memory”[1].Many psychiatric disorders in humans,such as autism spectrum disorder,attention deficit hyperactivity disorder,and schizophrenia,are characterized by social memory impairments.Patients with these disorders,along with corresponding animal models,often show defects associated with the thalamic reticular nucleus(TRN).The TRN,a thin layer of neurons surrounding the thalamus,mainly regulates and coordinates the transfer of information between the cortex and the thalamus,playing a role in higher brain functions such as consciousness,attention,and sensory processing.However,whether the TRN is involved in social memory remains unknown.展开更多
In the context of post-stimulation shale gas wells,the terms“shut-in”and“flowback”refer to two critical phases that occur after hydraulic fracturing(fracking)has been completed.These stages play a crucial role in ...In the context of post-stimulation shale gas wells,the terms“shut-in”and“flowback”refer to two critical phases that occur after hydraulic fracturing(fracking)has been completed.These stages play a crucial role in determining both the well’s initial production performance and its long-term hydrocarbon recovery.By establishing a comprehensive big data analysis platform,the flowback dynamics of over 1000 shale gas wells were analyzed in this work,leading to the development of an index system for evaluating flowback production capacity.Additionally,a shut-in chart was created for wells with different types of post-stimulation fracture networks,providing a structured approach to optimizing production strategies.A dynamic analysis method for flowback was also developed,using daily pressure drop and artificial fracture conductivity as key indicators.This method offers a systematic and effective approach to managing the shut-in and flowback processes for gas wells.Field trials demonstrated significant improvements:the probability of sand production was reduced,gas breakthrough time was extended,artificial fracture conductivity was enhanced,and the average estimated ultimate recovery(EUR)per well increased.展开更多
基金Hospital Pharmacy Research Foundation of Guangdong(Grant No.2022A14)。
文摘With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022.The participants were randomly assigned to an observation group and a control group.The observation group received pharmaceutical intervention,whereas the control group did not.The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population.The results revealed that after pharmaceutical intervention,there were no significant differences in medication adherence,medication appropriateness index(MAI),quantity of medicine,and potentially inappropriate medication(PIM)in the control group compared to before the intervention(P>0.05).However,the observation group showed significant improvement(P<0.05).The proportion of patients with good adherence increased from 57%to 78%,and the percentage of patients with MAI scores over 10 decreased from 60%to 40%.Moreover,there was a reduction in the number of medications prescribed,with only 47%of patients receiving more than five different types compared to the initial rate of 64%.Additionally,the occurrence of PIM declined from an initial rate of 64%to just 44%,surpassing that observed in the control group.Therefore,the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients,mitigate the risk of PIM,and promote rational medicine utilization.
文摘Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.
文摘Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral communication.
文摘AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 736 consecutive patients (415males, 321 females; mean age 43.6±16.6 years)undergoing colonoscopy during October 2001-March2002 Were prospectively enrolled in the study. The 2000ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered'generally indicated'; it was 'generally not indicated' for20%, and it was 'not listed' for 16% in the guidelines.The diagnostic yield of colonoscopy was highest for the 'generally indicated' (38%) followed by 'not listed'(13%) and 'generally not indicated' (5%) categories.In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was 'generally indicated' (odds ratio=12.3) and referrals by gastroenterologist (odds ratio = 1.9).CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications 'not listed' in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.
文摘AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI) endoscopy [381 for esophagogastroduodenoscopy(EGD) and 408 for colonoscopy] were prospectively enrolled in the study.The American Society for Gastrointestinal Endoscopy(ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic f indings.RESULTS:The overall inappropriate rate was 13.3%.The indications for EGD and colonoscopy were,respectively,appropriate in 82.7% and 82.6% of the exams,uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%.The diagnostic yield was signif icant higher forEGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate(EGD:36.6% vs 36.4% vs 11.4%,P = 0.004;Colonoscopy:24.3% vs 20.0% vs 3.3%,P = 0.001).Of the 25 malignant lesions detected,all but one was detected in exams judged appropriate or uncertain.CONCLUSION:This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations,namely in detecting neoplastic lesions.It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.
文摘<strong>Background:</strong> Computed tomography (CT) Scan is the imaging of choice for the diagnosis of sino nasal (SN) pathologies in sub-Saharan African setting. However, it is often requested by non experienced practitioners. We aimed to describe the utility and the appropriateness of CT Scan request forms and results in the diagnosis of SN pathologies. <strong>Method:</strong> We conducted a retrospective cross-sectional study in four health facilities in Yaoundé, Cameroun, from October 2018 to September 2019. All patients to whom SN CT Scan was performed were called for an appointment. After informed consent, data on the appropriateness and conformity of the request form were collected and compared to the guidelines of the French society of radiology. CT Scan results were also collected and the quality of the report was evaluated. <strong>Results:</strong> A total of 206 SN CT Scan request forms and reports were included, with a mean patient age of 37.7 ± 16.1 years. The request form was conformed to guidelines in 8.3% of cases and was found appropriate in 62.6% of cases. No CT Scan report had all the items required, and 159 (77.2%) reports were useful. The most common diagnosis in patients with abnormal results was chronic sinusitis (49.5%) and SN polyp or polyposis (19.4%). <strong>Conclusion:</strong> Most of SN CT Scan requested were appropriate and useful. However, the conformity of request forms and reports to the guidelines is low. Suggesting the need for capacity building for the diagnosis of SN pathologies especially for non specialists like general practitioners and nurses.
文摘Background: Preventive care of diabetic foot and eye complications is essential. However, data on the prevalence of and factors associated with screening of angiopathic complications in ambulatory patients with diabetes are very limited in Switzerland. We aimed to fill this gap of knowledge. Methods: Cross-sectional data on recommended preventive care using RAND’s criteria in a random sample of patients aged 50-80 years in 2005-2006. Participants were recruited from 4 Swiss university primary care settings (in Lausanne, Geneva, Zürich and Basel). Scores for general preventive care in patients with and without diabetes were calculated by using generalized estimating equation binomial models. Multivariate regression models were used to identify determinants of appropriateness of angiopathic complications prevention. The main outcome measure was appropriateness of screening for angiopathic complications based on the 2005 American Diabetes Association recommendations corresponding to the period of data collection. Results: Among the 1002 patients aged 50 - 80 years, 292 (29.1%) had diabetes (101/292 [34.6%] female, mean BMI 30.7 [SD 5.7]). Fifty-nine percent had appropriate preventive foot care and 55.8% had appropriate preventive eye care. Only 34.6% had appropriate preventive care of both foot and eye. No differences in aggregate scores for general preventive care in patients with and without diabetes were found (67.5% vs. 69.1%, p value 0.39). In multivariate model, obesity was negatively (OR = 0.28, 0.15 - 0.53) and hyperlipidemia positively (OR = 2.29, 1.20 - 4.38) associated with appropriate eye preventive care and with appropriate combined foot and eye preventive care (OR = 0.35, 0.18 - 0.70 for obesity and OR = 2.82, 1.24 - 6.40 for hyperlipidemia). Conclusions: Preventive care of diabetic angiopathic complications is low among ambulatory patients despite universal health care coverage. Particular attention should be paid to obese patients with diabetes.
文摘Purpose: This study aimed to develop teaching materials to prevent the dangers of ablution and bathing infants, based on the dangerous experiences of mothers and family members, and examine their appropriateness. Methods: A total of 20 midwives and public health nurses were selected as participants. Teaching materials and anonymous self-administered questionnaires were distributed, and the participants were asked to view the teaching materials and fill in the questionnaires. Retrieval was done by mail. The teaching materials included digital content, such as videos, sounds, and characters, which incorporated dangerous situations, preventions, and innovations in ablution and bathing procedures. The analysis was conducted by simple tabulation for each survey item. The free description was coded to preserve anonymity. This study was conducted with the approval of the Research Ethics Review Board of the authors’ affiliated university. Results: The teaching materials were found to be appropriate in terms of suitability to purpose, degree of difficulty of content, ease of viewing the videos, validity of time, appropriateness of expression, and usability. Conclusions: Ablution teaching materials that are used at the present time do not focus on dangers, and to date, no resources on bathing have been used as teaching materials. The created teaching materials in this study can be viewed multiple times, and mothers and family members who are unfamiliar with ablution and bathing can acquire knowledge regarding dangers and danger prevention. The addition of specific preventive measures and countermeasures for the occurrence of danger, along with practice, would result in the development of further appropriate teaching materials to reduce danger and alleviate anxiety.
文摘The Politeness Principle proposed by Leech complements Grice'Cooperative Principle to a certain extent in explaining the indirectness of language. However,the nature of politeness is its relativity.Determined by various factors such as social and cultural ones,the appropriateness of politeness at utterance level is affected by the appropriateness of the pragmatic distance between the participants. Different from the interpersonal relationships,pragmatic distance is calculated and determined in the process of communication varying with the variation of the communicative factors. Pragmatic distance is dynamic and can be maintained and altered by participants by using certain linguistic expressions to achieve the appropriateness of politeness in communication.
文摘Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice;2) To assess appropriateness colonoscopy using EPAGE criteria;3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%;27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years;p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.
文摘In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff’s feedback on residents’ behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists’ APDs through nursing staff’s monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff’s perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff’s positive participation in PUM intervention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.
文摘Background: Proton pump inhibitors (PPIs) are drugs that reduce the production of acid in the stomach. Recently, the use of PPI has been increasing among communities, whether with or without prescription. As a part of the healthcare team, the pharmacist should not only dispense medications but also ensure the appropriate use of these medications. Studies conducted within 16 countries showed substantial variation in the appropriateness of the use of PPI drugs. Aim: To evaluate the appropriateness of PPIs use in Sharjah, UAE based on surveys answered by pharmacists, physicians, and patients. Methods: A cross-sectional survey study was conducted on December 2017 at Sharjah, UAE as an example of information obtained from the Middle East. Two different surveys were conducted on physicians and pharmacists. Both Physicians and Pharmacists were chosen randomly from Yellow Pages. The results obtained from both studies were used to develop a patient’s survey, which was distributed among University of Sharjah students, their families and random people at Shopping Malls and Clinics. Results: The results obtained from the patients’ survey showed that ~39% of PPI users from the region of Sharjah are 25 - 44 years old. Approximately 79% are using PPI according to physicians’ prescriptions. Prescriptions’ duration is varied between 1 month (39%) and 6 months (22%), where 52% of PPI users ask their physicians to prescribe PPIs when needed. Suggested reasons for the use of PPI included inappropriate food habits (52%), use of other medications (16%) or bacterial infection (13%). Around 52% of the patients did not receive any recommendations regarding the deprescribing of PPIs. According to the pharmacists’ surveys, an average sale of 5 - 10 PPI packages is reported per day, and around 50% are sold without a prescription. Most pharmacists were not fully aware of the health conditions and side effects of PPI drugs. On the other hand, physicians’ surveys showed that PPIs were mainly prescribed in the case of GERD and ulcer and for a maximum of 2 - 4 weeks. Approximately 75% of physicians recommend changing regimen by reducing the dose and stopping in case of chronic use of PPIs. Conclusion: The results from this survey study indicated that even though most PPI consumers at Sharjah, UAE are well aware of the use of PPI drugs and they follow the instructions given by the Physicians’, there is some discrepancy in the information obtained by the physicians, pharmacists, and patients. The reason for this discrepancy may be attributed to the missing role of the pharmacists which is currently just dispensing the medications without appropriate counseling. Thus the appropriate role of the pharmacists should be implemented according to the known international guidelines.
基金supports by the National Natural Science Foundation of China(Nos.82201135)"2015"Cultivation Program for Reserve Talents for Academic Leaders of Nanjing Stomatological School,Medical School of Nanjing University(No.0223A204).
文摘Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion.This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence,aiming to provide general guidance on appropriate imaging examination selection,comprehensive and accurate imaging assessment for early orthodontic treatment patients.
文摘Aim: Myasthenia gravis (MG) is a rare and heterogeneous disease for which there is no generally accepted standard of care. Thus, it is critical that MG experts develop consensus guidelines based on their practice and disease management to assist clinicians and provide advice for insurance companies, health organizations and institutional review boards. Methods: An international treatment guidance was developed based on national guidelines established in the US, Denmark, Norway, Germany, Japan, Netherlands, United Kingdom and Europe. The RAND/UCLA appropriateness method (RAM) was applied to reach consensus among 15 worldly renowned experts and experienced clinicians. Results: This paper introduced the RAM procedure with its principles and applications and conducted a brief review of the resulting 2016 international consensus guidance for MG in comparison to clinical experience and management of Chinese MG patients. Conclusion: The 2016 international consensus guidance is a major contribution to the treatment and management of MG, providing an up-to-date expert consensus to assist clinicians around the world, especially those with limited experience and/or practice in countries/regions that have limited resources to develop local treatment guidelines. It is also an important contribution showing how RAM can help to develop consensus guidance for treatment of rare diseases based on scientific findings and expert experience.
基金supported by Healthy China initiative of Traditional Chinese Medicine(No.889042).
文摘Currently,the number of patients with myopia is increasing rapidly across the globe.Traditional Chinese medicine(TCM),with its long history and rich experience,has shown promise in effectively managing and treating this condition.Nevertheless,considering the vast amount of research that is currently being conducted,focusing on the utilization of TCM in the management of myopia,there is an urgent requirement for a thorough and comprehensive review.The review would serve to clarify the practical applications of TCM within this specific field,and it would also aim to elucidate the underlying mechanisms that are at play,providing a deeper understanding of how TCM principles can be effectively integrated into modern medical practices.Here,some modern medical pathogenesis of myopia and appropriate TCM techniques studies are summarized in the prevention and treatment of myopia.Further,we discussed the potential mechanisms and the future research directions of TCM against myopia.Identifying these mechanisms is crucial for understanding how TCM can be effectively utilized in this context.The combination of various TCM methods or the combination of traditional Chinese and Western medicine is of great significance for the prevention and control of myopia in the future.
文摘Objective: This study aims to analyze the distribution of positive human papillomavirus (HPV) infections among women of appropriate age in Beiliu City during cervical cancer screening in 2024, providing data support for subsequent public health interventions. Methods: A retrospective analysis was conducted on the HPV test results from January 1, 2024, to November 30, 2024, at Beiliu Maternal and Child Health Hospital. We statistically analyzed the positive rates of different HPV genotypes and the co-infection status of multiple genotypes. Results: A total of 7558 individuals were tested, with 1103 positive cases identified, resulting in a positivity rate of 14.59%. Among these, HPV type 52 had the highest positive rate, accounting for 18.47%. The co-infection analysis showed that there were 788 cases with single genotype positivity, 236 with double genotype positivity, and 58 with triple genotype positivity, while cases with multiple genotypes simultaneously positive were relatively rare. Conclusion: The HPV infection rate among women of appropriate age in Beiliu City is relatively high, especially for high-risk HPV types. To reduce the future incidence of cervical cancer, it is recommended to enhance health education and vaccination efforts for this population.
文摘The purpose of this study was to explore the application of TCM-appropriate technology in neurogenic bladder rehabilitation nursing.Firstly,the background and contents of the study were introduced.Then,it summarizes the definition and development of TCM-appropriate technology and expounds the main therapy and application of TCM-appropriate technology in the rehabilitation nursing field.Besides,the pathophysiological characteristics,rehabilitation nursing measures,and rehabilitation difficulties of the neurogenic bladder are described.Then,the application method,effect and prospect of TCM-suitable technology in rehabilitation nursing of neurogenic bladder are described.In addition,the object,method,result analysis,and conclusion of the experimental study are introduced,the main results of this study are summarized,and the future research direction is prospected.In summary,this study aims to provide effective TCM-appropriate technology for neurogenic bladder rehabilitation nursing and provide a reference for clinical practice and theoretical research in related fields.
基金supported by grants from the National Natural Science Foundation of China(32125018 and 32071005)Zhejiang Provincial Natural Science Foundation of China(LD24H090002)+3 种基金Nanhu Brain-computer Interface Institute(010904008)Innovative Research Team of High-level Local Universities in Shanghai(SHSMUZDCX20211102)Fundamental Research Funds for the Central Universities(226-2024-00133)the MOE Frontiers Science Center for Brain Science&Brain-Machine Integration of Zhejiang University.
文摘Social behaviors are crucial for gregarious animals,including humans.In order to exhibit appropriate behaviors in a complex social context,such as mating,aggression,avoidance,and cooperation,individuals need to remember their previous experiences with other members and accurately recognize them when they meet again.This ability is called“social memory”[1].Many psychiatric disorders in humans,such as autism spectrum disorder,attention deficit hyperactivity disorder,and schizophrenia,are characterized by social memory impairments.Patients with these disorders,along with corresponding animal models,often show defects associated with the thalamic reticular nucleus(TRN).The TRN,a thin layer of neurons surrounding the thalamus,mainly regulates and coordinates the transfer of information between the cortex and the thalamus,playing a role in higher brain functions such as consciousness,attention,and sensory processing.However,whether the TRN is involved in social memory remains unknown.
基金PetroChina Research Applied Science and Technology Project,“Shale Gas Scale Increase Production and Exploration andDevelopment Technology-Research and Application of Key Technology of Deep Shale Gas Scale Production”(No.2023ZZ21YJ01).
文摘In the context of post-stimulation shale gas wells,the terms“shut-in”and“flowback”refer to two critical phases that occur after hydraulic fracturing(fracking)has been completed.These stages play a crucial role in determining both the well’s initial production performance and its long-term hydrocarbon recovery.By establishing a comprehensive big data analysis platform,the flowback dynamics of over 1000 shale gas wells were analyzed in this work,leading to the development of an index system for evaluating flowback production capacity.Additionally,a shut-in chart was created for wells with different types of post-stimulation fracture networks,providing a structured approach to optimizing production strategies.A dynamic analysis method for flowback was also developed,using daily pressure drop and artificial fracture conductivity as key indicators.This method offers a systematic and effective approach to managing the shut-in and flowback processes for gas wells.Field trials demonstrated significant improvements:the probability of sand production was reduced,gas breakthrough time was extended,artificial fracture conductivity was enhanced,and the average estimated ultimate recovery(EUR)per well increased.
