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关键词： Pressure injuries   pressure sores   pressure ulcers   wound healing   wound infection  

摘要： Although widely considered to be preventable, pressure ulcers (PU) are common and cause a significant burden to the individual, their carers and healthcare services. International collaborative panels publish consensus documents and guidelines aiming to standardize PU classification, assessment and management. There is a huge emphasis on prevention, which requires awareness and education for clinicians, patients and carers. Surgeons may be referred patients with PU for advice on surgical options or management of infected wounds. Surgical patients may develop PU after prolonged surgical procedures, during periods of critical illness or in association with their surgical condition. Additionally, as some PU become chronic and non-healing, individuals with PU may be referred for assessment of other medical issues. An awareness and understanding of PU aetiology, management strategies and complications are therefore important for the surgical trainee. © 2021

ISBN: (纸本)9787565443923

关键词： Pharmacotherapy   Pharmacology/Toxicology   Internal Medicine  

摘要： Background Factor Xa inhibitors (FXaIs) are increasingly used without having sufficient drug-drug interaction data. Using a microdosed cocktail methodology could support filling the knowledge gap quickly. Methods In a randomised crossover trial, we investigated the drug-drug interactions between six oral azole antifungals and a microdosed FXaI cocktail containing 25 mu g rivaroxaban, 25 mu g apixaban, and 50 mu g edoxaban. Additionally, different enzyme activities were also monitored using a microdosed cocktail approach. The six different azole antifungals were administered in therapeutic doses over a 24 h period, while the microdosed cocktails were administered 1 h after administration of the azole antifungals. Results Ketoconazole and posaconazole were the strongest perpetrators, showing similar increases as apixaban (area under the concentration-time curve ratio [AUCR] 1.64 and 1.62, respectively) and edoxaban (AUCR 2.08 and 2.1, respectively), whereas ketoconazole increased rivaroxaban 2.32-fold but only increased posaconazole 1.37-fold. All other azole antifungals showed less perpetrator effects on the FXaIs. Cytochrome P450 (CYP) 3A inhibition was confirmed using microdosed midazolam, with ketoconazole also the most potent perpetrator (8.42-fold). Conclusion Drug-drug interactions for three victim drugs of the same drug class (FXaIs) with different clearance mechanisms can be studied using a microdosed cocktail approach. Using members of the azole antifungal drug class as perpetrators, multiple interactions can be studied in one trial, and a more detailed insight into the underlying interaction mechanisms is possible.

关键词： Obesity   Risk factors   Medicine/Public Health   general   Public Health   Epidemiology   Internal Medicine   Metabolic Diseases   Health Promotion and Disease Prevention  

摘要： Objectives (1) To explore individual and family characteristics related to anthropometric and cardiometabolic health indicators and (2) examine whether characteristics that correlate with cardiometabolic health indicators differ across severity of obesity at time of entry to Canadian pediatric weight management clinics. Methods We conducted a cross-sectional analysis of 2-17 year olds with overweight or obesity who registered in the CANadian Pediatric Weight Management Registry (CANPWR) between May 2013 and October 2017 prior to their first clinic visit. Individual modifiable health behaviors included dietary intake, physical activity, screen time, and sleep. Family characteristics included parental BMI, family medical history, socioeconomic status and family structure. Linear mixed effects stepwise regression analysis was performed to determine which characteristics were related to each health indicator: BMI z-score;waist circumference;waist to height ratio;blood pressure;glycemia;HDL cholesterol;non-HDL cholesterol;triglycerides. Results This study included 1296 children (mean age +/- standard deviation: 12.1 +/- 3.5 years;BMI z-score: 3.55 +/- 1.29;95.3% with obesity). Hours spent sleeping (estimated beta = -0.10;95% CI [-0.15, -0.05], p = 0.0001), hours per week of organized physical activity (estimated beta = -0.32;95% CI [-0.53, -0.11], p = 0.0026), daily sugared drink intake (estimated beta = 0.06;95% CI [0.01, 0.10], p = 0.0136) and maternal BMI (estimated beta = 0.03;95% CI [0.02, 0.04], p < 0.0001) were associated with BMI z-score (adj. R-2 = 0.2084), independent of other individual and family characteristics. Physical activity, total sugared drink intake and sleep duration were associated with glycemia and non-HDL cholesterol, independent of child BMI z-score. However, irrespective of obesity severity, little of the variance (0.86-11.1%) in cardiometabolic health indicators was explained by individual modifiable health behaviors. Conclusions Physical acti

关键词： Cardiology   Pharmacotherapy   Pharmacology/Toxicology  

摘要： The author names previously read as: Adrija Hajra, Manasvi Gupta, Binita Ghosh, Kumar Ashish, Neelkumar Patel, Gaurav Manek, Devesh Rai, Dhrubajyoti Bandyopadhyay, Carl J. Lavie Should read as: Adrija Hajra, Manasvi Gupta, Binita Ghosh, Kumar Ashish, Neelkumar Patel, Gaurav Manek, Devesh Rai, Jayakumar Sreenivasan, Akshay Goel, Carl J. Lavie, Dhrubajyoti Bandyopadhya The original article has been corrected.

关键词： bipolar   schizophrenia   treatment   weight  

摘要： People with serious mental illness (SMI) have identified barriers to engaging in behavioral weight management interventions (BWMIs). We assessed whether BWMIs that addressed these barriers were more effective. First, we systematically reviewed qualitative literature and used a thematic analysis to identify the characteristics of BWMIs that promote engagement for adults with SMI. Second, we systematically reviewed randomized controlled trials (RCTs) of BWMIs in adults with SMI. Data on the characteristics that promoted engagement and weight outcomes were extracted. We then used a crisp-set qualitative comparative analysis (CsQCA) to identify which characteristics were associated with weight loss. For the qualitative review, 20 studies in 515 people with SMI were analyzed and nine characteristics were reported to promote engagement in BWMIs. For the systematic review, 34 RCTs testing 36 interventions in 4305 participants were included. The active interventions resulted in more weight loss (mean = -4.37 to +1 kg at 6 weeks to 18 months follow-up) compared with controls (-1.64 to +3.08 kg). The CsQCA showed BWMIs that offered regular contact, tools to support enactment, and tailored materials were associated with effectiveness. As these are all supplementary strategies, it may be possible to augment BWMIs available for the general population to engage people with SMI.

关键词： Alcohol and other drug (AOD) treatment   Workforce   Competitive tendering   Contract length   Vulnerability   New public management  

摘要： Objective: Both public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia. Methods: The study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections: (1) the service (e.g., treatment types);(2) workforce (e.g., total number of staff);and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length). Results: Government providers were more likely to provide medically oriented treatment types such as withdrawal management and pharmacotherapy, whereas nongovernment organization (NGO) providers were more likely to offer rehabilitation. Consistent with this, government services were more likely to employ medical professionals and nurses, indicative of a more medically oriented workforce, while NGO services were more likely to employ AOD workers, youth workers, peer workers, and counselors. Our data illustrate that NGO services were more likely to be subject to competitive tendering and to have shorter contract lengths, compared with government services, and overall to be more structurally vulnerable. Conclusion: Despite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangeme

关键词： Cardiology   Pharmacotherapy   Pharmacology/Toxicology  

摘要： Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.

关键词： characteristics   sustainable development goals   sustainable HRM  

摘要： Sustainable human resource management (HRM) has been evolving for more than 15 years. It builds on strategic HRM (SHRM). Sustainable HRM is built around broad organisational goals in a number of areas, not just 'business' goals. Central to this approach is the link between HRM and sustainability. Sustainable HRM seeks to achieve positive economic, social, human and environmental outcomes simultaneously, in the short term and the long term. The 2030 Agenda for Sustainable Development established Sustainable Development Goals. These provide strategies, goals, activities and management practices which human resource practitioners can apply to further sustainability outcomes. This link with sustainability has contributed to studies in areas very different to SHRM and required consideration of additional theories for insights into Sustainable HRM. This article identifies six characteristics of Sustainable HRM which explain the divergence with SHRM. These characteristics are contradictory outcomes, concern with capability development, the need to recognise potential and actual positive and negative outcomes, attention to the development and implementation of HRM activities, the explicit statement of values informing Sustainable HRM and the design of metrics to promote sustainability.

关键词： 项目沟通管理   沟通渠道   沟通方法   机房线束项目  

摘要： 随着信息化时代的不断发展,项目制在业界越来越普遍。我国电梯行业新成立的企业数量正不断上升,电梯行业产量逐年增多。电梯作为连接高层建筑与纵向道路之间的主要工具,在日常生活与工作环境中扮演着重要的角色。D公司在机房线束项目管理过程中,出现了诸多沟通问题,影响了项目管理绩效。因此,有必要对D公司机房线束项目的沟通管理问题展开针对性研究,从而通过改善项目沟通效率和效果,提升项目整体的管理绩效。 本论文以D公司机房线束项目沟通管理案例为研究对象。通过查阅国内外相关研究成果并学习项目沟通管理理论知识,结合D公司机房线束项目的实际情况,依据沟通管理中的不同过程组,即规划过程、管理过程、监督过程分别甄选出相关的案例并对存在的主要沟通问题进行描述,包括可交付成果沟通不明确、会议沟通效率较低、项目信息变更沟通不充分等。在此基础上,结合沟通管理的基本流程、沟通管理理论知识、沟通渠道相关理论以及相关分析工具等对这些主要沟通问题进行成因分析,找出这些问题的关键,包括沟通需求分析不充分,沟通渠道和方式不当以及沟通过程缺少监督。进一步根据问题的成因进行解决方案的设计,结合D公司的现状分别从加强沟通管理计划编制,完善项目沟通渠道和沟通方式,建立项目沟通的监督和评估机制三个方面进行方案设计。最后,从组织保障、制度保障以及文化保障进行措施落实,以确保方案的有效实施。 本论文研究的目的是帮助D公司解决机房线束项目运作中存在的沟通管理问题,形成一个高效的团队。不仅为D公司内部工作的顺利开展提供有效保障,而且对外部的沟通也提供有力支持。同时,也希望为其它公司面临类似沟通管理问题提供重要的借鉴意义。