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关键词： 科学管理  

ISBN: (纸本)9787030713353

摘要： 《复杂科学管理》由教育部人文社会科学重点研究基地清华大学技术创新研究中心与中国技术经济学会复杂科学管理分会共同主办，是国内唯一致力于介绍复杂科学管理的基本理论、方法、应用及最新发展的学术集刊。本集刊以“学术创新，学术民主”为宗旨，刊载复杂科学管理领域内高质量的学术论文，包括理论探讨、实证分析、案例解读、文献综述和评论等。本集刊共收录6篇文章，研究主题涉及“复杂系统视域下金融股权知识关联特征分析与风险识别”“人力资本对突破性创新行为的影响研究”“工业园区安全生产托管服务质量监管博弈研究”“基础地理数据智理”“知识和数据共同驱动的群体性突发事件预警体系”“康养产业是否接近了起飞的临界状态”。

关键词： Continuity of   Patient Care   Drug tapering   General practice   Opioids   Pharmacists   Patient safety  

摘要： Background Opioid prescribing has escalated, particularly long-term in chronic noncancer pain. Innovative models of care have been recommended to augment regulatory and harm-minimisation strategies and to review the safety and benefits of opioids for the individual patient. Medication stewardship and pharmacist integration are evolving approaches for general practice. Aim To explore enablers, barriers, and outcomes of a pharmacist-led intervention to improve opioid management in general practice, from the perspectives of general practitioners (GPs) and practice personnel. Method The study was part of a mixed-methods investigation into a general practice pharmacist pilot. Qualitative data relevant to opioids were analysed. Data from 13 semi-structured interviews were coded, analysed iteratively and thematically, and interpreted conceptually through the framework of Opioid Stewardship fundamentals proposed by the National Quality Forum. Results Seven themes and 14 subthemes aligned with stewardship fundamentals. Participants considered organisational policy, supported by leadership and education, fostered collaboration and consistency and improved practice safety. Patient engagement with individualised resources, 'agreements' and 'having the conversation' with the pharmacist enabled person-centred opioid review and weaning. GPs reported greater accountability and reflection in their practices, in the broader context of opioid prescribing and dilemmas in managing patients transitioning through care. Receiving feedback on practice deprescribing outcomes encouraged participants' ongoing commitment. Patient communication was deemed an early barrier;however, learnings were applied when transferring the model to other high-risk medicines. Conclusion Improved opioid management was enabled through implementing pharmacist-led coordinated stewardship. The findings offer a practical application of guideline advice to individualise opioid deprescribing.

关键词： Surgical Oncology   Oncology   Surgery  

关键词： Cholecystitis   Clinical practice guidelines   Cholecystectomy   Emergency surgery  

摘要： Background Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level. Aim To identify, through an international prospective nonrandomized cohort study, the epidemiology and areas of practice variability in management of acute complicated calculous biliary disease (ACCBD) and to correlate them against reported outcomes. Methods A preplanned analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Complicated Biliary Calculous Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. All eligible patients with acute complicated biliary calculous disease were recorded contemporaneously using a standardized predetermined protocol and a secure online database and followed-up through to 60 days from their admission. Endpoints A two-stage data collection strategy collecting patient demographics, details of operative, endoscopic and radiologic intervention, and outcome metrics. Outcome measures included mortality, surgical morbidity, ICU stay, timing of operative intervention, and length of hospital stay. Results Three hundred thirty-eight patients were included, with a mean age of 65 years and 54% were female. Diagnosis at admission were: cholecystitis (45.6%), biliary pancreatitis (21%), choledocholithiasis with and without cholangitis (13.9% and 18%). Index admission cholecystectomy was performed in just 50% of cases, and 28% had an ERCP performed. Morbidity and mortality were low. Conclusion This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich 'real world' insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and infor

关键词： Chimeric antigen receptor T-cell therapy   CAR T-cell   Hypogammaglobulinemia   B-cell aplasia   Infections   IgG   IVIG   Immunoglobulin replacement   Review  

摘要： Chimeric antigen receptor (CAR) T-cell therapy is a dynamic therapy of engineered T cells targeting neoplastic cells, which offers impressive long-term remissions for aggressive relapsed/refractory hematologic malignancies. However, side effects including severe infections can be life-threatening. Multiple factors, including cytokine release syndrome, B-cell aplasia, and hypogammaglobulinemia, contribute to infection risk. B-cell aplasia is an expected on-target, off-tumor effect of CD19(+)- targeted CART cells and leads to hypogammaglobulinemia. We review hypogammaglobulinemia observed in the 5 currently Food and Drug Administration-approved CAR T-cell therapies and other CAR T-cell products evaluated in clinical trials, and discuss hypogammaglobulinemia onset, duration, and immune recovery. We review associations between hypogammaglobulinemia and infections, with a discussion informed by other known B-cell-depleting contexts. Differences in hypogammaglobulinemia between children and adults are identified. We integrate management strategies for evaluation and immunoglobulin replacement from clinical studies, expert recommendations, and organizational guidelines. Notably, our review also highlights newer CAR T-cell products targeting different B-cell antigens, including B-cell maturation antigen, signaling lymphocytic activation molecule, and K light chains. Finally, we identify key areas for future study to mitigate and treat hypogammaglobulinemia resulting from this transformative therapy. (C) 2021 American Academy of Allergy, Asthma & Immunology

关键词： Acute appendicitis   Pediatrics   Ultrasound   Conservative treatment   Mucosal ulceration  

摘要： Purpose To determine whether specific ultrasonographic features can predict failure of conservative treatment of acute appendicitis. Methods A 2-year retrospective study was conducted on children admitted with acute appendicitis. Those with uncomplicated appendicitis diagnosed solely by ultrasound, and treated conservatively, were followed 18-24 m to assess treatment outcome. Management was considered successful if recurrent acute appendicitis was not observed during follow-up. Appendix diameter, wall thickness, presence of mucosal ulceration, hyperechogenic fat, free fluid, and lymph nodes were evaluated as potential discriminatory ultrasonographic predictors. T-tests, chi-square, sensitivity, specificity, and odds ratios were calculated. Results Out of 556 consecutive patients that were admitted with acute appendicitis, 180 (32%) managed conservatively. One hundred eleven (62%) imaged by US only. Ninety-two out of 111 (83%) were followed 18-24 m to assess treatment outcome, and 19/111 (17%) were lost to follow-up. Conservative management was successful in 72/92 (78.2%), with treatment failure in 20/92 (21.8%) (5/92 (5.4%) with recurrent acute appendicitis and 15/92 (16.3%) underwent appendectomy). Of the ultrasonographic features studied, mucosal ulceration demonstrated statistically significant predictive value. Fifteen out of 20 (75%) treatment failures had mucosal ulceration, compared to 21/72 (29.2%) of the patients with successful treatment (p < 0.001). This yielded a positive odds ratio of 7.3 (2.3-22.6, 95% CI), 70.8% (58.9-80.9, 95% CI) specificity, and 75% (50.9-91.3, 95% CI) sensitivity. Positive predictive value was 41.6% (31.5-52.5, 95% CI) while intact mucosa had negative predictive value of 91% (82.4-95.6, 95% CI) for conservative management success. Conclusion The presence or absence of appendiceal mucosal ulceration at ultrasound can predict conservative management outcome in the setting of acute appendicitis, potentially improving pediatric patien

关键词： 企业管理   跨文化管理   人事管理  

ISBN: (纸本)9787508099996

摘要： 无论你在国内还是国外工作，在如今越来越全球化和虚拟化的世界，想取得商业成功，必须具有跨越文化差异的能力。著名学者艾琳·梅耶是你的向导，带你穿过这一微妙，有时甚至是危险之境-人们背景显著不同，但他们需要在一起和谐工作。即使有英语这一全球通用语言，陷入文化陷阱、危害职业生涯和脆弱合作的事情也常有发生。在《跨文化沟通力》中，艾琳·梅耶提供了一个工作现场验证有效的模型，破解了跨国企业管理的文化障碍难题。她将一个智慧的分析框架和实践性、易上手的行动指导融于一体，教你如何在全球化的世界中取得成功。

摘要： What is known and objective Outpatient parenteral antibiotic therapy (OPAT) is an attractive option for patients who require parenteral antimicrobials as outpatients. Few OPAT studies have assessed the impact of IV antibiotic therapy via elastomeric continuous pumps, with most having been conducted outside the United States and few in county hospitals. The OPAT program in Harris Health system, the county hospital system of Houston, Texas, United States, has implemented a disposable elastomeric continuous infusion pump (eCIP) for self-administered intravenous antibiotics (s-OPAT) since December 2018. Our goal was to describe the clinical characteristics of patients discharged with an eCIP, as well as the safety and cost-effectiveness of this pump. Methods We retrospectively analysed patients discharged from Harris Health hospitals between 12/2018 and 02/2021 with s-OPAT via eCIP at home. We extracted various patient characteristics and outcomes related to OPAT. Results and discussion Among 481 OPAT patients during the study period, 91 patients received s-OPAT via eCIP. A total of 1925 days of s-OPAT were administered at home, with a median duration of 12 days. Eighty-three patients (93.4%) achieved a cure from infection, six patients (6.6%) had side effects, and nine patients (9.9%) experienced 30-day hospital readmission. Twenty-two patients (24.2%) presented to the ED during s-OPAT, with 13 patients (14.3%) presenting with PICC line concerns. We estimated that s-OPAT via eCIP saved $2,360,500 to $3,503,900 compared to inpatient-only therapy. What is new and conclusion Our study showed that patients with s-OPAT via eCIP had a high cure rate with a relatively low incidence of side effects and 30-day hospital readmission. ED visits during therapy were relatively high, which indicates the necessity of close patient monitoring via the OPAT program. eCIP appears to be a good option to facilitate an early disposition of patients in county hospitals.

关键词： nitrate modeling   landscape characteristics   climatic variablity   management practice  

摘要： Nitrate (NO3-N) mobilization is generally controlled by available sources, hydrological connectivity, and biogeochemical transformations along the dominant flow paths. However, their spatial heterogeneity and complex interactions often impede integrated understanding of NO3-N dynamics at the catchment scale. To fully integrate spatiotemporal information for NO3-N simulations, a grid-based model, mHM-Nitrate, was applied to a 68 km(2) lowland, mixed land use catchment (Demnitzer Millcreek, DMC) near Berlin. The model successfully captured the spatiotemporal distribution of flow and NO3-N between 2001 and 2019, but was less successful in 1992-2000 due to land management changes. Re-optimization of relative parameters was subsequently conducted for this period to understand management effects. The simulated results revealed landscape characteristics and hydroclimatic variability as the main controlling factors on respective spatial and temporal patterns. The combined effects of vegetation cover and fertilizer inputs dictated the spatial distribution of water and NO3-N fluxes, while wetness condition determined the temporal NO3-N dynamics by regulating hydrological connectivity and NO3-N mobilization. Denitrification was also closely coupled with hydroclimatic conditions, which accounted for similar to 20% of NO3-N inputs. In contrast, restoration of riparian wetlands had a modest impact on NO3-N export (similar to 10% reduction during 2001-2019), suggesting further interventions (e.g., reducing fertilizer application or increased wetland areas) are needed. Our modeling application demonstrated that mHM-Nitrate could provide robust spatially distributed simulations of hydrological and NO3-N fluxes over a long-term period and could successfully differentiate the key controlling factors. This underlines the model's value in contributing to an evidence base to guide future management practices under climate change.

关键词： Dentistry  

摘要： Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices. Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics;b) working environment;and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents. Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75;31.4% [95% CI 26%, 38%]) and saliva testing (17;7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (chi(2) = 6.27;p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (chi(2) = 34.98;p <0.001) more likely to restore teeth with amalgam. Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.