Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income count...Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.展开更多
The problem of data island hinders the application of big data in artificial intelligence model training,so researchers propose a federated learning framework.It enables model training without having to centralize all...The problem of data island hinders the application of big data in artificial intelligence model training,so researchers propose a federated learning framework.It enables model training without having to centralize all data in a central storage point.In the current horizontal federated learning scheme,each participant gets the final jointly trained model.No solution is proposed for scenarios where participants only provide training data in exchange for benefits,but do not care about the final jointly trained model.Therefore,this paper proposes a newboosted tree algorithm,calledRPBT(the originator Rights Protected federated Boosted Tree algorithm).Compared with the current horizontal federal learning algorithm,each participant will obtain the final jointly trained model.RPBT can guarantee that the local data of the participants will not be leaked,while the final jointly trained model cannot be obtained.It is worth mentioning that,from the perspective of the participants,the scheme uses the batch idea to make the participants participate in the training in random batches.Therefore,this scheme is more suitable for scenarios where a large number of participants are jointly modeling.Furthermore,a small number of participants will not actually participate in the joint training process.Therefore,the proposed scheme is more secure.Theoretical analysis and experimental evaluations show that RPBT is secure,accurate and efficient.展开更多
目的对医患沟通的临床实践指南进行方法学和报告质量评价,以期确定高质量指南,提供临床参考。方法通过检索MEDLINE(PubMed)、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普(VIP),补充医脉通、用药助手、丁香园网站的相...目的对医患沟通的临床实践指南进行方法学和报告质量评价,以期确定高质量指南,提供临床参考。方法通过检索MEDLINE(PubMed)、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普(VIP),补充医脉通、用药助手、丁香园网站的相关临床实践指南(CPG),使用AGREEⅡ和RIGHT工具进行指南质量评价,采用组内相关系数(ICC)用于评估评审者对每个项目理解的一致性。结果共纳入2份临床实践指南,每个领域的评审人员的总体一致性是可以接受的。AGREEⅡ评价结果显示,2篇指南推荐级别均为B级,CPG所有7个领域的平均报告率为50.64%,其中领域1最高(88.89%),领域3最低(30.95%)。RIGHT评价结果显示,指南平均报告率为29.22%。结论医患沟通相关指南质量与数量仍有待提高,指南制订者应严格按照AGREEⅡ和RIGHT的要求规范撰写,以期提出高水平、高标准的循证指南,来指导医护人员的临床实践。展开更多
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a di...The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.展开更多
Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary emb...Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.展开更多
An emerging healthcare delivery model is enabling a new era of clinical care based on well-informed decision-making processes.Current healthcare information systems(HISs)fall short of adopting this model due to a conf...An emerging healthcare delivery model is enabling a new era of clinical care based on well-informed decision-making processes.Current healthcare information systems(HISs)fall short of adopting this model due to a conflict between information security needed to implement the new model and those already enforced locally to support traditional care models.Meanwhile,in recent times,the healthcare sector has shown a substantial interest in the potential of using blockchain technology for providing quality care to patients.No blockchain solution proposed so far has fully addressed emerging cross-organization information-sharing needs in healthcare.In this paper,we aim to study the use of blockchain in equipping struggling HISs to cope with the demands of the new healthcare delivery model,by proposing HealthyBlockchain as a granular patient-centered ledger that digitally tracks a patient’s medical transactions all along the treatment pathway to support the care teams.The patient-centered ledger is a neutral tamper-proof trail timestamp block sequence that governs distributed patient information across the decentralized discrete HISs.HealthyBlockchain connects patients,clinicians,and healthcare providers to facilitate a transparent,trustworthy,and secure supporting platform.展开更多
China has established a two-level normative structure AIDS notification system with the AIDS Prevention and control Regulations as the core and local regulations as the supplement The problem is that the local legisla...China has established a two-level normative structure AIDS notification system with the AIDS Prevention and control Regulations as the core and local regulations as the supplement The problem is that the local legislations have different provisions with regard to the subject of notification and whether to adopt mandatory notification, which confronts the implementation of the AIDS notification system and the prevention of AIDS transmission with real difficulties The different attitudes of local legislations to the mandatory notification system for AIDS essentially reflects the dilemma of legislators in balancing the right to privacy of HIV-infected patients and the right to health of their sexual partners from the perspective of rights limitations, this paper aims to conducts interest balance analysis in the aspects of social urgency, public interest, substantive damage and the right to know of others and holds the view that when these two rights conflict with each other, priority should be given to the right to health of HIV-infected patients and their sexual partner as well as public health In terms of specific systems, the AIDS Prevention and control Regulations should establish a mandatory notification system and local legislation should take into consideration of local conditions to make specific provisions on issues of notification subject, notification procedures and confidentiality obligations after notification.展开更多
HIV screening can be used to detect,control and prevent the spread of HIV/AIDS.The attitude towards HIV screening relates to the general trend of human rights protection of AIDS sufferers and infectors.HIV exceptional...HIV screening can be used to detect,control and prevent the spread of HIV/AIDS.The attitude towards HIV screening relates to the general trend of human rights protection of AIDS sufferers and infectors.HIV exceptionalism has been adopted in traditional international practice.That means the specific notified,voluntary consent shall be obtained from examinees before they are screened.However,there is move to abandon HIV exceptionalism in order to detect more infectors and treat AIDS the same as another infectious disease.This has resulted in 'compulsory screening' and 'consent after notification'.In China, 'voluntary' screening, 'real-name detection' and 'compulsory screening' exist in different regions.Thus,it is crucial to identify the legal regulation principle of HIV screening from the perspective of human rights.展开更多
Introducing the human rights perspective into the multi-dimensional governance of human genome editing activities would help define boundaries for the behaviors of stakeholders such as the state, researchers, ethics c...Introducing the human rights perspective into the multi-dimensional governance of human genome editing activities would help define boundaries for the behaviors of stakeholders such as the state, researchers, ethics committee members, and the public, and clarify specific practices of these subjects or entities to meet the requirements of human rights obligations. Based on the human dignity principle, humans must never be used as a means to an end in scientific research. The right to physical and mental health requires the implementation of the principles of informed consent, the primacy of life, and risk control in genome editing, as well as the proper treatment of embryos. The right to privacy corresponds to the confidentiality obligations and non-intervention obligations of relevant parties, and the protection of sensitive personal information points to the special compliance requirements regarding information processing. Differential treatment of genome-edited humans requires objective and reasonable justification, and should also meet the requirements of the proportionality principle.展开更多
目的梳理分析健康医疗数据共享背景下中国患者隐私保护相关研究现状,以期为未来相关领域的研究提供参考。方法检索2018—2023年中国知网、万方数据库中有关患者隐私保护的期刊文献,使用Cite Space 6.2.R5软件进行关键词聚类分析和关键...目的梳理分析健康医疗数据共享背景下中国患者隐私保护相关研究现状,以期为未来相关领域的研究提供参考。方法检索2018—2023年中国知网、万方数据库中有关患者隐私保护的期刊文献,使用Cite Space 6.2.R5软件进行关键词聚类分析和关键词突现分析,结合文献具体内容梳理患者隐私保护研究现状。结果共纳入1590篇文献进行分析;发文量最多的核心期刊为《中国医学伦理学》(54篇,3.40%);中国患者隐私保护领域研究现状可概括为医疗护理活动相关隐私问题、医疗服务新技术引发的隐私问题以及特殊情境下的隐私问题;关键词突现分析显示“个人信息”“数据共享”是当前热点研究主题。结论健康医疗数据共享背景下,患者隐私保护仍是研究热点及重点。目前研究对患者隐私保护的定义较为局限,建议未来从多角度出发,深入挖掘多方对于隐私保护的认识,丰富患者隐私保护内涵。此外,还需加强医务人员患者隐私保护意识和行为实践培养,不断实践患者隐私保护技术的安全性及有效性,进一步完善特殊时期及健康数据共享背景下的个人隐私保护相关立法。展开更多
文摘Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.
基金National Natural Science Foundation of China(Grant No.61976064)the National Natural Science Foundation of China(Grant No.62172123).
文摘The problem of data island hinders the application of big data in artificial intelligence model training,so researchers propose a federated learning framework.It enables model training without having to centralize all data in a central storage point.In the current horizontal federated learning scheme,each participant gets the final jointly trained model.No solution is proposed for scenarios where participants only provide training data in exchange for benefits,but do not care about the final jointly trained model.Therefore,this paper proposes a newboosted tree algorithm,calledRPBT(the originator Rights Protected federated Boosted Tree algorithm).Compared with the current horizontal federal learning algorithm,each participant will obtain the final jointly trained model.RPBT can guarantee that the local data of the participants will not be leaked,while the final jointly trained model cannot be obtained.It is worth mentioning that,from the perspective of the participants,the scheme uses the batch idea to make the participants participate in the training in random batches.Therefore,this scheme is more suitable for scenarios where a large number of participants are jointly modeling.Furthermore,a small number of participants will not actually participate in the joint training process.Therefore,the proposed scheme is more secure.Theoretical analysis and experimental evaluations show that RPBT is secure,accurate and efficient.
文摘目的对医患沟通的临床实践指南进行方法学和报告质量评价,以期确定高质量指南,提供临床参考。方法通过检索MEDLINE(PubMed)、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普(VIP),补充医脉通、用药助手、丁香园网站的相关临床实践指南(CPG),使用AGREEⅡ和RIGHT工具进行指南质量评价,采用组内相关系数(ICC)用于评估评审者对每个项目理解的一致性。结果共纳入2份临床实践指南,每个领域的评审人员的总体一致性是可以接受的。AGREEⅡ评价结果显示,2篇指南推荐级别均为B级,CPG所有7个领域的平均报告率为50.64%,其中领域1最高(88.89%),领域3最低(30.95%)。RIGHT评价结果显示,指南平均报告率为29.22%。结论医患沟通相关指南质量与数量仍有待提高,指南制订者应严格按照AGREEⅡ和RIGHT的要求规范撰写,以期提出高水平、高标准的循证指南,来指导医护人员的临床实践。
文摘The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
文摘Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.
基金funding from Ibn Khaldun Fellowship for Saudi Women in partnership with the Center for Clean Water and Clean Energy at MITthe Deanship of Scientific Research at King Saud University through research Group No.RG-1438-002。
文摘An emerging healthcare delivery model is enabling a new era of clinical care based on well-informed decision-making processes.Current healthcare information systems(HISs)fall short of adopting this model due to a conflict between information security needed to implement the new model and those already enforced locally to support traditional care models.Meanwhile,in recent times,the healthcare sector has shown a substantial interest in the potential of using blockchain technology for providing quality care to patients.No blockchain solution proposed so far has fully addressed emerging cross-organization information-sharing needs in healthcare.In this paper,we aim to study the use of blockchain in equipping struggling HISs to cope with the demands of the new healthcare delivery model,by proposing HealthyBlockchain as a granular patient-centered ledger that digitally tracks a patient’s medical transactions all along the treatment pathway to support the care teams.The patient-centered ledger is a neutral tamper-proof trail timestamp block sequence that governs distributed patient information across the decentralized discrete HISs.HealthyBlockchain connects patients,clinicians,and healthcare providers to facilitate a transparent,trustworthy,and secure supporting platform.
基金Research on Legalization of Basic Medical Care Service(project approval No.14JZD025)as a key project of research on philosophy and social sciences of the Ministry of Education in 2014
文摘China has established a two-level normative structure AIDS notification system with the AIDS Prevention and control Regulations as the core and local regulations as the supplement The problem is that the local legislations have different provisions with regard to the subject of notification and whether to adopt mandatory notification, which confronts the implementation of the AIDS notification system and the prevention of AIDS transmission with real difficulties The different attitudes of local legislations to the mandatory notification system for AIDS essentially reflects the dilemma of legislators in balancing the right to privacy of HIV-infected patients and the right to health of their sexual partners from the perspective of rights limitations, this paper aims to conducts interest balance analysis in the aspects of social urgency, public interest, substantive damage and the right to know of others and holds the view that when these two rights conflict with each other, priority should be given to the right to health of HIV-infected patients and their sexual partner as well as public health In terms of specific systems, the AIDS Prevention and control Regulations should establish a mandatory notification system and local legislation should take into consideration of local conditions to make specific provisions on issues of notification subject, notification procedures and confidentiality obligations after notification.
文摘HIV screening can be used to detect,control and prevent the spread of HIV/AIDS.The attitude towards HIV screening relates to the general trend of human rights protection of AIDS sufferers and infectors.HIV exceptionalism has been adopted in traditional international practice.That means the specific notified,voluntary consent shall be obtained from examinees before they are screened.However,there is move to abandon HIV exceptionalism in order to detect more infectors and treat AIDS the same as another infectious disease.This has resulted in 'compulsory screening' and 'consent after notification'.In China, 'voluntary' screening, 'real-name detection' and 'compulsory screening' exist in different regions.Thus,it is crucial to identify the legal regulation principle of HIV screening from the perspective of human rights.
基金phased result of the project “study on the legislation of genome editing in human embryos”(Project No. 19SFB2035)National Rule of Law and Legal Theory Research Program by the Ministry of Justice in 2019。
文摘Introducing the human rights perspective into the multi-dimensional governance of human genome editing activities would help define boundaries for the behaviors of stakeholders such as the state, researchers, ethics committee members, and the public, and clarify specific practices of these subjects or entities to meet the requirements of human rights obligations. Based on the human dignity principle, humans must never be used as a means to an end in scientific research. The right to physical and mental health requires the implementation of the principles of informed consent, the primacy of life, and risk control in genome editing, as well as the proper treatment of embryos. The right to privacy corresponds to the confidentiality obligations and non-intervention obligations of relevant parties, and the protection of sensitive personal information points to the special compliance requirements regarding information processing. Differential treatment of genome-edited humans requires objective and reasonable justification, and should also meet the requirements of the proportionality principle.
文摘目的梳理分析健康医疗数据共享背景下中国患者隐私保护相关研究现状,以期为未来相关领域的研究提供参考。方法检索2018—2023年中国知网、万方数据库中有关患者隐私保护的期刊文献,使用Cite Space 6.2.R5软件进行关键词聚类分析和关键词突现分析,结合文献具体内容梳理患者隐私保护研究现状。结果共纳入1590篇文献进行分析;发文量最多的核心期刊为《中国医学伦理学》(54篇,3.40%);中国患者隐私保护领域研究现状可概括为医疗护理活动相关隐私问题、医疗服务新技术引发的隐私问题以及特殊情境下的隐私问题;关键词突现分析显示“个人信息”“数据共享”是当前热点研究主题。结论健康医疗数据共享背景下,患者隐私保护仍是研究热点及重点。目前研究对患者隐私保护的定义较为局限,建议未来从多角度出发,深入挖掘多方对于隐私保护的认识,丰富患者隐私保护内涵。此外,还需加强医务人员患者隐私保护意识和行为实践培养,不断实践患者隐私保护技术的安全性及有效性,进一步完善特殊时期及健康数据共享背景下的个人隐私保护相关立法。