AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes.
BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma(HCC). Hepatitis B vaccination is 95% effective in preventing infection and the develo...BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma(HCC). Hepatitis B vaccination is 95% effective in preventing infection and the development of chronic liver disease and HCC due to hepatitis B. In 2011, the Centers for Disease Control updated their guidelines recommending that adults at high-risk for hepatitis B infection be vaccinated against hepatitis B including those with diabetes mellitus(DM). We hypothesize that adults at high-risk for hepatitis B infection are not being adequately screened and/or vaccinated for hepatitis B in a large urban healthcare system.AIM To investigate clinical factors associated with Hepatitis B screening and vaccination in patients at high-risk for Hepatitis B infection.METHODS We conducted a retrospective review of 999 patients presenting at a large urban healthcare system from 2012-2017 at high-risk for hepatitis B infection. Patients were considered high-risk for hepatitis B infection based on hepatitis B practice recommendations from the Center for Disease Control. Medical history including hepatitis B serology, concomitant medical diagnoses, demographics, insurance status and social history were extracted from electronic health records.Multivariate logistic regression was used to identify clinical risk factors independently associated with hepatitis B screening and vaccination.RESULTS Among the 999 patients, 556(55.7%) patients were screened for hepatitis B. Of those who were screened, only 242(43.5%) patients were vaccinated against hepatitis B. Multivariate regression analysis revealed end-stage renal disease[odds ratio(OR): 5.122; 2.766-9.483], alcoholic hepatitis(OR: 3.064; 1.020-9.206),and cirrhosis or end-stage liver disease(OR: 1.909; 1.095-3.329); all P < 0.05 were associated with hepatitis B screening, while age(OR: 0.785; 0.680-0.906),insurance status(0.690; 0.558-0.854), history of DM(OR: 0.518; 0.364-0.737), and human immunodeficiency virus(OR: 0.443; 0.273-0.718); all P < 0.05 were instead not associated with hepatitis B screening. Of the adults vaccinated for hepatitis B,multivariate regression analysis revealed age(OR: 0.755; 0.650-0.878) and DM were not associated with hepatitis B vaccination(OR: 0.620; 0.409-0.941) both P <0.05.CONCLUSION Patients at high-risk for hepatitis B are not being adequately screened and/or vaccinated. Improvements in hepatitis B vaccination should be strongly encouraged by all healthcare systems.展开更多
目前主要通过电容式电压互感器(capacitance type voltage transformer,CVT)二次电压和红外测温数据发现运行CVT状态异常,而具体故障类型通过停电试验和解剖确定,检修试验工作缺乏针对性,效率低。停电前对CVT故障类型进行诊断,可提高停...目前主要通过电容式电压互感器(capacitance type voltage transformer,CVT)二次电压和红外测温数据发现运行CVT状态异常,而具体故障类型通过停电试验和解剖确定,检修试验工作缺乏针对性,效率低。停电前对CVT故障类型进行诊断,可提高停电后故障处理针对性和效率。基于此以CVT末屏电流变化率、二次电压变化率和电磁单元温度差为特征,建立CVT高压电容击穿、中压电容击穿、电磁单元故障三种典型故障的物元模型。通过计算待评CVT与典型故障模型的关联度对待评CVT的故障类型进行诊断。经实例分析验证该诊断方法可对故障CVT的故障类型做出正确诊断,提高状态异常CVT停电检修试验针对性。展开更多
目的评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web ofScience等数据库,从建库至2023年11月所有有关...目的评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web ofScience等数据库,从建库至2023年11月所有有关安宁疗护筛查工具应用于急诊科患者的研究,由2名研究者独立进行文献筛选、资料提取和文献质量评价,采用Stata 15.0软件对资料数据进行Meta分析。结果共纳入20篇文献,包含20122例患者,一共涉及6种筛查工具,其中最常用的是惊讶问题(Surprise Questions,SQ)(n=9),其次是急诊安宁疗护快速筛查工具(the Palliative Care and Rapid Emergency Screening,P-CaRES)(n=7)及急诊科姑息治疗和临终关怀需求筛查工具(the Screen for Palliative and End-of-life care needs in the Emergency Department,SPEED)(n=2)。9项研究通过评估SQ预测患者病死率从而确定安宁疗护需求,总体而言,SQ预测病死率的敏感度为0.72(0.59,0.82),特异度为0.74(0.62,0.84),均为中等。SQ预测长期病死率(1年内、2年内)的敏感度0.75(0.64,0.84)高于预测短期病死率(1个月内、3个月内)的敏感度0.65(0.35,0.86)。此外,就1年内急诊入院或频繁急诊科就诊而言,SQ敏感度为0.72(0.41,0.90)、特异度为0.52(0.32,0.72)。P-CaRES预测安宁疗护需求合并敏感度为0.73(0.57,0.85)、特异度为0.64(0.48,0.77)。结论用于急诊科安宁疗护筛查的工具中SQ应用最广泛,其次是P-CaRES,两种工具在预测患者未来1年病死率方面均具有中等敏感度和特异度,但该结论仍需高质量、大样本研究进一步验证。展开更多
基金Supported by NHS Bowel Cancer Screening ProgrammeDrs.Matharoo and Sevdalis are affiliated with the Imperial Centre for Patient Safety and Service Quality(www.cpssq.org),affiliated with the Imperial Patient Safety Translational Research Centre,which is funded by the National Institute for Health Research
文摘AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes.
文摘BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma(HCC). Hepatitis B vaccination is 95% effective in preventing infection and the development of chronic liver disease and HCC due to hepatitis B. In 2011, the Centers for Disease Control updated their guidelines recommending that adults at high-risk for hepatitis B infection be vaccinated against hepatitis B including those with diabetes mellitus(DM). We hypothesize that adults at high-risk for hepatitis B infection are not being adequately screened and/or vaccinated for hepatitis B in a large urban healthcare system.AIM To investigate clinical factors associated with Hepatitis B screening and vaccination in patients at high-risk for Hepatitis B infection.METHODS We conducted a retrospective review of 999 patients presenting at a large urban healthcare system from 2012-2017 at high-risk for hepatitis B infection. Patients were considered high-risk for hepatitis B infection based on hepatitis B practice recommendations from the Center for Disease Control. Medical history including hepatitis B serology, concomitant medical diagnoses, demographics, insurance status and social history were extracted from electronic health records.Multivariate logistic regression was used to identify clinical risk factors independently associated with hepatitis B screening and vaccination.RESULTS Among the 999 patients, 556(55.7%) patients were screened for hepatitis B. Of those who were screened, only 242(43.5%) patients were vaccinated against hepatitis B. Multivariate regression analysis revealed end-stage renal disease[odds ratio(OR): 5.122; 2.766-9.483], alcoholic hepatitis(OR: 3.064; 1.020-9.206),and cirrhosis or end-stage liver disease(OR: 1.909; 1.095-3.329); all P < 0.05 were associated with hepatitis B screening, while age(OR: 0.785; 0.680-0.906),insurance status(0.690; 0.558-0.854), history of DM(OR: 0.518; 0.364-0.737), and human immunodeficiency virus(OR: 0.443; 0.273-0.718); all P < 0.05 were instead not associated with hepatitis B screening. Of the adults vaccinated for hepatitis B,multivariate regression analysis revealed age(OR: 0.755; 0.650-0.878) and DM were not associated with hepatitis B vaccination(OR: 0.620; 0.409-0.941) both P <0.05.CONCLUSION Patients at high-risk for hepatitis B are not being adequately screened and/or vaccinated. Improvements in hepatitis B vaccination should be strongly encouraged by all healthcare systems.
文摘目前主要通过电容式电压互感器(capacitance type voltage transformer,CVT)二次电压和红外测温数据发现运行CVT状态异常,而具体故障类型通过停电试验和解剖确定,检修试验工作缺乏针对性,效率低。停电前对CVT故障类型进行诊断,可提高停电后故障处理针对性和效率。基于此以CVT末屏电流变化率、二次电压变化率和电磁单元温度差为特征,建立CVT高压电容击穿、中压电容击穿、电磁单元故障三种典型故障的物元模型。通过计算待评CVT与典型故障模型的关联度对待评CVT的故障类型进行诊断。经实例分析验证该诊断方法可对故障CVT的故障类型做出正确诊断,提高状态异常CVT停电检修试验针对性。
文摘目的评价常用的安宁疗护筛查工具识别急诊科患者安宁疗护需求的准确性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、CINAHL、Web ofScience等数据库,从建库至2023年11月所有有关安宁疗护筛查工具应用于急诊科患者的研究,由2名研究者独立进行文献筛选、资料提取和文献质量评价,采用Stata 15.0软件对资料数据进行Meta分析。结果共纳入20篇文献,包含20122例患者,一共涉及6种筛查工具,其中最常用的是惊讶问题(Surprise Questions,SQ)(n=9),其次是急诊安宁疗护快速筛查工具(the Palliative Care and Rapid Emergency Screening,P-CaRES)(n=7)及急诊科姑息治疗和临终关怀需求筛查工具(the Screen for Palliative and End-of-life care needs in the Emergency Department,SPEED)(n=2)。9项研究通过评估SQ预测患者病死率从而确定安宁疗护需求,总体而言,SQ预测病死率的敏感度为0.72(0.59,0.82),特异度为0.74(0.62,0.84),均为中等。SQ预测长期病死率(1年内、2年内)的敏感度0.75(0.64,0.84)高于预测短期病死率(1个月内、3个月内)的敏感度0.65(0.35,0.86)。此外,就1年内急诊入院或频繁急诊科就诊而言,SQ敏感度为0.72(0.41,0.90)、特异度为0.52(0.32,0.72)。P-CaRES预测安宁疗护需求合并敏感度为0.73(0.57,0.85)、特异度为0.64(0.48,0.77)。结论用于急诊科安宁疗护筛查的工具中SQ应用最广泛,其次是P-CaRES,两种工具在预测患者未来1年病死率方面均具有中等敏感度和特异度,但该结论仍需高质量、大样本研究进一步验证。
