United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment

AIM: To assess advanced neuroendocrine tumor (NET) treatment patterns and resource utilization by tumor progression stage and tumor site in the United States. METHODS: United States Physicians meeting eligibility criteria were provided with online data extraction forms to collect patient chart data on recent NET patients. Resource utilization and treatment pattern data were collected over a baseline period (after diagnosis and before tumor progression), as well as initial and secondary progression periods, with progression defined according to measureable radiographic evidence of tumor progression. Resource categories used in the analysis include: Treatments (e.g. , surgery, chemotherapy, radiotherapy, targeted therapies), hospitalizations and physician visits, diagnostic tests (biomarkers, imaging, laboratory tests). Comparisons between categories of resource utilization and tumor progression status were examined using univariate (by tumor site) and multivariate analyses (across all tumor sites). RESULTS: Fifty-five physicians were included in the study and completed online data extraction forms using the charts of 110 patients. The physician sample showed a relatively even distribution for those affiliated with academic versus community hospitals (46% vs 55%). Forty (36.3%) patients were reported to have pancreatic NET (pNET), while 70 (63.6%) patients had gastrointestinal tract (GI)/Lung as the primary NET site. Univariate analysis showed the proportion of patients hospitalized increased from 32.7% during baseline to 42.1% in the progression stages. While surgeries were performed at similar proportions overall at baseline and progression, pNET patients, were more likely than GI/Lung NET patients to have undergone surgery during the baseline (33.3% vs 25.0%) and any progression periods (26.7% vs 23.4%). While peptide-receptor radionuclide and targeted therapy utilization was low across NET types and tumor stages, GI/Lung types exhibited greater utilization of these technologies compared to pNET. Chemotherapy utilization was also greater among GI/Lung types. Multivariate analysis results demonstrated that patients in first progression period were over 3 times more likely to receive chemotherapy when compared to baseline (odds ratio: 3.31; 95%CI: 1.46-7.48, P=0.0041). Further, progression was associated with a greater likelihood of having a study physician visit [relative risk (RR): 1.54; 95%CI: 1.10-2.17, P=0.0117], and an increased frequency of other physician visits (RR: 1.84; 95%CI: 1.10-3.10, P=0.0211). CONCLUSION: Resource utilization in advanced NET in the United States is significant overall and data suggests progression has an impact on resource utilization regardless of NET tumor site.

Understanding practice patterns of glaucoma sub-specialists in India

AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This survey,conducted in 2013,was based on an interactive audience response system.RESULTS：The information was obtained from 146 glaucoma specialists.Approximately half（n=83;57%）had≥10y of experience in managing glaucoma and were in institutional practice（n=74,51%）.Goldmann applanation tonometry was preferred by 103（72%）specialists whilst n=25（17.4%）used non-contact tonometer.Indentation gonioscopy was favoured by two-thirds（n=90,66%）whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed（n=115,86%and n=114;83%respectively）.Nearly three quarter specialists（n=96;72%）preferred optical coherence tomography for imaging.The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser（iridotomy,n=117;93%）and medical management（prostaglandin analogue,n=104;78%）,respectively.Approximately only a third of the specialists surveyed（n=37;28%）were performing both trabeculectomy and implantation of a glaucoma drainage device and about half（n=64;47%）were not operating on congenital glaucoma at all.CONCLUSION：This survey has found conformance with preferred practice patterns in several areas of diagnosisand management of glaucoma,but there was diversity in a few areas.The information is a significant step towards improvement of glaucoma care in India,including planning for future strategies.

On Treatment Patterns for Modeling Medical Treatment Processes in Clinical Practice Guidelines

Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.

Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns

Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.

Adjuvant therapy for hormone receptor-positive breast cancer: Perspective from a survey on breast cancer physicians' acceptance of practice-changing data

A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.

新时期我国结核病防治服务体系建设及展望

中国结核病防治服务体系是随着疫情水平的变化和经济社会的发展不断调整变化的。自2011年,中国逐步推行新型结核病防治服务体系。进入新时代,如何更好地健全和完善结核病防治服务体系,是结核病防治工作面临的重大问题。作者系统总结了中国结核病防治服务体系的演变沿革,阐述了结核病防治服务体系运行现状,分析了其中存在的问题和挑战,对结核病防治服务体系建设提出了工作意见和建议,并展示了未来发展前景。

国际冬季两项发展格局、实践经验及启示

冬季两项是冬季奥运会7个大项之一。对于国际冬季两项发展格局进行深入研究,并从实践中汲取经验与启示,有助于促进我国雪上运动项目在后冬奥时代的有效发展。本研究运用文献资料、专家访谈及逻辑分析等研究方法,以北京冬奥会冬季两项比赛成绩为基础分析冬季两项运动国际发展格局,并以此为切入点对挪威等冬季两项强国的发展实践进行研究,最终提出对我国的启示。研究得出,国际发展冬季两项运动实践经验包括:优化管理体系,实现资源合理配置;发挥协会作用,打通项目发展堵点;借助媒体宣传,促进大众广泛关注;注重文化传承,营造浓厚体育氛围;依托旅游资源,保障赛事有效开展。启示:完善冬季两项竞赛体系,推动赛事产业化发展和市场化运营;注重多元媒体的宣传和冬季两项运动文化内涵的挖掘;完善冬季两项运动管理组织与服务保障体系。

新发展格局下体育竞赛表演业产业链韧性提升的耦合逻辑、风险因素与实践方略

依托新发展格局,提升体育竞赛表演业产业链韧性是产业链现代化建设和体育竞赛表演业高质量发展的重要议题。本文运用文献资料法、逻辑分析法,结合产业链韧性的内涵将体育竞赛表演业产业链韧性拆解为补链、疏链和强链能力,具体表现为产业链在面对外部压力或风险时的冲击抵抗能力、恢复重构能力和核心竞争能力,此“三力要素”与构建新发展格局存在高度耦合。在此基础上识别新发展格局下体育竞赛表演业产业链韧性提升的风险因素:断链风险,核心技术自主创新能力不足;堵链风险,竞赛表演市场供求关系失衡;弱链风险,复合型体育人才本土供给不足。据此提出实践方略:补链方面,以完善的数字基础设施构建体育竞赛表演产业生态体系;疏链方面,以供给侧结构性改革调和体育竞赛表演市场供求关系;强链方面,以多元化渠道提升体育竞赛表演业人才要素流通效率。

“国潮”背景下文创产品的设计思路

目的分析“国潮”文化元素的特征,探究“国潮”文化元素在文创产品设计中的应用策略,为设计师提供更多的思路,从而提高文创产品设计水平,增强文化自信。方法采用文献资料法和案例法进行研究,在文化主题、形式风格和表现手法这三个方面探讨了“国潮”文化元素在文创产品设计中的应用,同时也论述了“国潮”应用的几点原则。结论文创产品设计师应该充分认识到传统文化的重要价值,在文化主题、形式风格和表现手法这三个方面借鉴“国潮”文化元素,并遵循实用性原则、时尚性原则和艺术性原则,从而提升文创产品的生命力。

新时代“小先生制”的教育实践样态重塑——基于人类学视角分析

基于人类学视角分析新时代“小先生制”教育实践样态,发掘新时代“小先生制”的实践价值,有助于深化对教育和文化相互关系的理解。站在人类教育广阔的社会背景下去审视、去传承人类文化教育的精髓,创新切合时代要求的教育生活实践。文章从“角色互换、教学同构”“道德成长、美德浸润”“和谐相融、共处共生”三方面重塑了新时代“小先生制”的教育实践样态,并分析了新时代“小先生制”教育实践样态重塑中需要注意的问题。

淮剧艺术特征解析及设计因子应用探寻

在非遗活态化传承的时代背景下,非遗文创产品的开发对于非遗文化的传承与保护有着重要意义。而作为国家级非物质文化遗产的淮剧,是集文学、音乐、美术、舞蹈、杂技于一体的综合艺术,极具美学与文化价值。通过梳理淮剧艺术视觉元素的构成,从形态、图案、色彩三方面提取其中具代表性、典型性的文化符号,结合现代创意设计方法,探究淮剧元素融入现代生活的新载体,更好地延续其文化基因,助力淮剧文化的活态化传承。

乡村振兴背景下精准施策模式探析——基于云南省会泽县实践案例

巩固拓展脱贫攻坚成果同乡村振兴有效衔接是云南这样曾经的脱贫攻坚主战场省份“三农”工作的主要任务。云南省曲靖市会泽县具有脱贫人口基数大、成效明显和进一步巩固拓展脱贫攻坚成果压力大的典型性。近年来会泽县以习近平总书记关于“三农”工作的重要论述为根本遵循,在实践中丰富拓展了精准扶贫精准脱贫思想,形成了以人员管理的精准守牢不发生规模性返贫的底线、以帮扶措施的精准保障脱贫户持续增收的基本经验。会泽县精准施策模式的关键在于通过精准研判,制定了精准管理政策,再分层分类精准落实帮扶措施。会泽县的实践探索是对习近平总书记精准扶贫、精准脱贫思想的丰富和拓展,对其他脱贫县有较好的借鉴意义。同时会泽县当前在巩固成果上还面临产业发展难、村庄空心化和脱贫群众素质偏低的难题,需要在实践中坚持以精准思想为指引,与时俱进探索更加符合实际的精准举措。

从纺织图案设计到终端产品开发——“纺织图案设计”课程教学改革探索与实践

纺织图案设计应该满足消费需求和工艺要求,设计专业应该从前端设计开始,培养人才学会发现和创造美,为终端产品的功能化提供多样性和时尚性结合的优秀作品。

基于扎根理论的护理干预联合知信行模式健康教育在老年性阴道炎患者中的应用效果

目的:分析基于扎根理论的护理干预联合知信行模式健康教育在老年性阴道炎(SV)患者中的应用效果。方法:选取2022年7月—2023年6月徐州市妇幼保健院妇科收治的SV患者70例作为研究对象,依据随机数字表法分为干预组与对照组,各35例。对照组实施常规护理,干预组实施基于扎根理论的护理干预联合知信行护理模式。比较两组护理效果。结果:护理后,干预组不明确性、复杂性、信息缺乏性、不可预测性评分低于对照组,自我管理技能、责任感、自我概念、健康知识、生理、心理、环境、社会评分高于对照组,差异有统计学意义(P<0.05)。结论:基于扎根理论的护理干预联合知信行模式健康教育在SV患者中的应用效果显著,可提高患者疾病认知水平及生活质量,加强患者自我管理能力。

新形势下地方政府招商引资的创新实践与策略研究——以甘肃省为例

研究着眼于破解地方政府招商引资工作困局,以甘肃省为例,采用线上+线下方式,面向全省招商引资落户企业和政府工作人员,开展问卷调查、实地考察、现场座谈等,分析了经济新常态下招商引资工作现状和政策执行情况,从产业链招商、园区承载力、项目招引落地、招商工作队伍、招商政策优化等维度,深入剖析地方政府招商引资工作中存在的问题,梳理总结其他地区招商引资政策与模式的做法和启示,提出了推进落实五大政策支持体系,健全“五位一体”服务体系,持续完善五大工作机制,全面优化市场环境、政务环境、法治环境、人文环境“四大环境”等实践策略,以期为地方政府高效推进招商引资工作提供借鉴。

生物炭施加垄沟集雨种植对水土流失及紫花苜蓿草产量的影响

为缓解我国黄土高原区干旱胁迫和控制水土流失,本研究采用裂区设计,生物炭施加模式(生物炭施加和无生物炭施加)为主区,耕作模式(打结垄、开敞垄和平作)为副区,研究不同生物炭施加模式和耕作模式对土壤水分、径流、泥沙流失、养分流失、紫花苜蓿(Medicago sativa L.)干草产量和水分利用效率的影响。试验结果表明,在2019和2020年紫花苜蓿生育期,与平作处理相比,开敞垄和打结垄处理的径流量、泥沙、全氮、全磷、有机质流失量分别减少20.1%~37.7%和60.1%~64.7%,54%~75.5%和77.1%~87.6%,44.4%~65.5%和49.0%~81.8%,36.7%~75.3%和48.6%~87.3%,48.2%~72.9%和58.6%~85.4%,土壤贮水量、紫花苜蓿干草产量和水分利用效率分别增加39.5~52.1和31.2~60.5 mm,26.2%~31.7%和26.5%~35.2%,10.07~14.86和12.14~16.55 kg·hm^(-2)·mm^(-1)。与无生物炭施加处理相比,生物炭施加处理的径流量、泥沙、全氮、全磷和有机质流失量分别减少48%~69%,94%~125%,12%~24%,28%~46%和35%~48%,土壤贮水量、紫花苜蓿干草产量和水分利用效率分别增加42.93~26.09 mm,106%~111%和1.96~6.90 kg·hm^(-2)·mm^(-1)。本研究表明,生物炭施加打结垄沟集雨种植是该区域适宜耕作模式。

2022年美国眼科学会屈光不正临床实践指南解读

2022年9月,美国眼科学会发布了最新版的屈光不正临床实践指南(PPP),该PPP基于最佳的循证医学证据,为屈光不正的诊断和矫正提供权威的指导意见。新版PPP延续了2017版严谨、全面、精细的特点,在屈光不正的定义、流行病学、分类以及诊断和矫正等多方面进行更新。如新版PPP将高度屈光不正定义为近视≥-6.0 D;远视≥+3.0 D;散光≥-3.0 D;增加关于近视防控的内容,建议每天户外活动至少2 h,选择恰当的光学防控手段,并可考虑点用低浓度阿托品滴眼液以期延缓近视的发生和发展等;丰富了近视是遗传与环境因素交互影响的循证医学证据,同时强调了未来高度近视的大流行趋势,延缓近视进展具有全球公共卫生意义。此外,新版PPP首次强调近视可引起不可逆性视力损伤,提示要推迟儿童近视发生时间,延缓近视进展速度等。笔者就新版PPP的主要内容和更新的近视防控部分内容进行介绍和解读。

基于通阳理论的叶桂肿胀用药配伍规律数据挖掘

目的:基于数据挖掘技术,探究叶桂治疗肿胀的用药配伍规律。方法:收集和整理《临证指南医案》肿胀篇医案及方药,用office 2010建立数据库,进行频数分析,应用IBM SPSS Modeler 18.0的Apriori算法进行关联规则分析,采用SPSS Statistics 26.0进行因子分析。结果:共纳入83例处方,涉及药物117味,用药频数共计527次,高频药(频次≧10次)共15味,其中最高频单味药为茯苓、厚朴、生白术,对药以桂枝-甘草的使用频次最高,药物类别以化痰药、温里药、利水渗湿药为主;药性以温性为主,寒热并调;药味以辛、苦为主;归经以归脾、胃、肺经者最多;聚类分析中将15味高频中药聚为7类时效果最佳;关联规则分析出2组最常用药对;因子分析共提取出6个公因子。结论:叶桂治疗肿胀以通阳利水为要法,善用茯桂剂以奏温中通阳,化气利水之功,重脾肺、倡温补、善通利,务在宣肺、健脾、温肾,扶阳助气,上下并调,使阳气通达全身,通条水利,恢复人体气、血、津、液的正常功能,以达营卫调和、肿胀自除之效。

农村研学旅行助力乡村振兴的实践模式研究

乡村振兴战略是党的十九大做出的重大决策部署,是决胜全面建成小康社会、全面建设社会主义现代化强国的重大战略。研学旅行作为一种新型的教育方式,有利于促进学生综合素质提升和全面发展,符合国家战略和时代要求,受到广泛关注。为了充分发挥研学旅行作用,助力乡村振兴,本文将展开相关研究,主要论述了研学旅行的概念及特点、农村研学旅行与乡村振兴之间的关系,然后对其实践模式进行了分析,望能提供参考帮助。