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  • 文章类型: Journal Article
    背景:首席执行官(CEO)是医疗保健组织不可或缺的领导者。在过去的二十年中,在美国(US)医院,有人指出,首席执行官的离职率正在增加,据报道,私营部门的首席执行官离职率从2008年的14%上升到2017年的18%。在澳大利亚,人们发现,在两年的时间里,41名高管有18个不同的职位。有人强调,首席执行官离职率的增加是澳大利亚和国际医疗保健组织的主要问题。首席执行官更替的一些负面影响包括组织不稳定,高昂的财务成本,人力资本的损失以及对员工士气和病人护理的不利影响。
    目标:我们的范围审查旨在绘制和总结与健康和非健康环境中的CEO失误相关的证据,并回答以下问题:1.CEO离职的原因是什么?2.什么是最小化CEO更替的策略?
    结果:解释目标的协议,本范围审查的纳入标准和方法已提前规定并公布.这项范围审查包括在31年期间发表的17项研究(13项健康和4项非健康环境),这些研究调查并描述了CEO离职率的增加。所有17项研究都确定了首席执行官离职的原因,以及某些研究确定了首席执行官留任的促进者。我们将CEO离职的原因分为三个主要主题:组织,性能,和个人。组织因素包括首席执行官因组织内部问题而离职,绩效因素包括首席执行官的工作问题和个人因素抓住首席执行官离职的个人原因。
    结论:首席执行官们承受着巨大的压力,要在满足内部和外部利益相关者利益的同时,实现良好的业绩和推动增长。CEO离职有各种原因,但最常见的因素是组织。
    BACKGROUND: Chief Executive Officer\'s (CEO) are integral leaders of health care organisation. Over the last two decades in United States (US) hospitals, it has been noted that CEO turnover rates are increasing, and it was reported that the CEO turnover rates have augmented from 14% in 2008 to 18% in 2017 in the private sector. In Australia, it was discovered that during two years, 41 executives had 18 distinct positions. It has been highlighted that the increasing CEO turnover is a major issue for Australian and international health care organisations. Some of the negative consequences of CEO turnover include organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care.
    OBJECTIVE: Our scoping review aimed to map and summarise the evidence associated with CEO turnovers in both health and non-health setting, and answer the following questions: 1. What are the reasons for CEO departure?, 2. What are the strategies to minimise CEO turnover?
    RESULTS: A protocol explaining the objectives, inclusion criteria and methods for this scoping review were specified in advance and published. This scoping review included 17 studies (13 health and 4 non-health setting) published over a 31-year period that investigated and described the increasing CEO turnover rates. All 17 studies identified causes of CEO turnover along with certain studies identifying facilitators of CEO retention. We classified CEO\'s departure reasons into three major themes: organizational, performance, and personal. Organisational factors include CEO departures due to issues within the organisation, performance factors include issues with CEO\'s work and personal factors captures personal reasons for CEO\'s leaving their job.
    CONCLUSIONS: CEOs are under immense pressure to deliver good results and drive growth while satisfying the interests of internal and external stakeholders. There are various reasons for CEO\'s departure however the most common factor identified is organisational.
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  • 文章类型: Journal Article
    近年来,对小鼠活动和行为的不受干扰的家庭笼子记录受到越来越多的关注。并行,为了自动化数据收集和解释,已经开发了几种技术。由于这些不断扩展的技术,可以长期记录和保存大量数据集,提供大量有关动物健康的信息,临床状态,基线活动,以及实验干预情况下的后续偏差。这样的大数据集也可以作为科学数据的长期储备,可以根据需要重新分析和重新利用。在这次审查中,我们介绍了家庭笼子监测(HCM)数据采集产生的大数据的影响,特别是通过数字通风笼(DVC),可以通过增强细化来支持3R的应用,Reduction,甚至取代动物研究。
    Undisturbed home cage recording of mouse activity and behavior has received increasing attention in recent years. In parallel, several technologies have been developed in a bid to automate data collection and interpretation. Thanks to these expanding technologies, massive datasets can be recorded and saved in the long term, providing a wealth of information concerning animal wellbeing, clinical status, baseline activity, and subsequent deviations in case of experimental interventions. Such large datasets can also serve as a long-term reservoir of scientific data that can be reanalyzed and repurposed upon need. In this review, we present how the impact of Big Data deriving from home cage monitoring (HCM) data acquisition, particularly through Digital Ventilated Cages (DVCs), can support the application of the 3Rs by enhancing Refinement, Reduction, and even Replacement of research in animals.
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  • 文章类型: Journal Article
    初次全膝关节置换术(TKA)期间的计算机辅助导航手术(CAS)可能有助于改善关节外畸形(EAD)患者的预后;然而,这还没有得到广泛的研究。因此,我们旨在研究EAD患者使用CAS进行初次TKA后的临床和放射学结局.
    我们搜索了Medline,Embase,以及截至2023年3月3日的Cochrane图书馆,用于研究使用TKA导航系统治疗EAD患者的手术结果。从14项研究中,纳入539例接受导航TKA的EAD患者。我们研究了膝盖运动范围(ROM),最终随访结果评分(膝关节社会评分[KSS]和膝关节功能评分[KFS]),使用下肢扫描图,术前和术后机械髋-膝-踝(mHKA)角度。荟萃分析基于单臂法,所有数据均使用随机效应模型进行汇总.
    在我们的荟萃分析之后,平均膝关节ROM从87.0°变化(95%置信区间[CI],术前75.9°-98.1°)至术后109.4°(95%CI,97.9°-120.8°)。调整后的KSS为93.45点(95%CI,88.36-98.54点),在接受CAS-TKA的EAD患者中,校正后的KFS为91.57分(95%CI,86.80-96.33分)。作为放射学结果,mHKA角度从术前169.53°(95%CI,166.90°-172.16°)变为术后178.81°(95%CI,178.31°-179.30°)。
    CAS-TKA取得了积极的临床结果,并显示出令人满意的下肢机械轴对准。CAS-TKA显示出主要TKA程序的希望,即使在涉及EAD的复杂病例中,也能证明良好的临床和放射学结果。
    UNASSIGNED: Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD.
    UNASSIGNED: We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model.
    UNASSIGNED: Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively.
    UNASSIGNED: CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb\'s mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.
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  • 文章类型: Meta-Analysis
    目的:术前贫血增加术后发病率,死亡率,和同种异体输血的风险。然而,在接受全髋关节置换术和全膝关节置换术(TKA)的患者中,术前贫血的发生率及其与术后结局的关系尚未见报道.
    方法:我们通过PubMed进行了全面的文献检索,科克伦图书馆,辛辛恩之网,和Embase从开始到2023年7月,调查全关节置换术患者术前贫血的患病率,手术前贫血和非贫血患者之间的合并症,和术后结果。分析术后结局.使用随机效应模型计算总体患病率,研究之间的异质性通过Cochran的Q检验进行检验,并通过I2统计量进行量化。进行亚组分析和荟萃回归分析以确定异质性的来源。通过漏斗图评估发表偏倚,并通过Egger检验进行验证。
    结果:共纳入21项研究,共369,101个样本,所有研究均为回顾性队列研究.3项研究质量高,18项研究质量中等。结果表明,等待关节置换术的患者术前贫血的患病率为22%;亚组分析显示,等待全膝关节置换术的患者术前贫血的患病率最高;美洲发现术前贫血的患病率最高;女性人群的术前贫血发生率高于男性人群;有术前贫血史的术前贫血发生率在女性人群中高于男性人群。有术前贫血史的患者;有术前贫血史的关节置换患者感染风险增加,术后输血率,术后输血,下肢深静脉血栓,在医院的日子,三个月内重新入院,和死亡率与术前没有贫血的患者相比。
    结论:等待全关节置换术的患者术前贫血的患病率为22%,在TKA和接受翻修的女性患者中更高,而术前贫血不利于患者的术后恢复,会增加术后并发症的风险,输血率,在医院的日子,再入院率,和死亡率。
    OBJECTIVE: Preoperative anemia increases postoperative morbidity, mortality, and the risk of allogeneic transfusion. However, the incidence of preoperative anemia in patients undergoing total hip arthroplasty and total knee arthroplasty (TKA) and its relationship to postoperative outcomes has not been previously reported.
    METHODS: We conducted a comprehensive literature search through PubMed, Cochrane Library, Web of Sincien, and Embase from inception to July 2023 to investigate the prevalence of preoperative anemia in patients undergoing Total Joint Arthroplasty, comorbidities between anemic and non-anemicpatients before surgery, and postoperative outcomes. postoperative outcomes were analyzed. Overall prevalence was calculated using a random-effects model, and heterogeneity between studies was examined by Cochran\'s Q test and quantified by the I2 statistic. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and validated by Egger\'s test.
    RESULTS: A total of 21 studies with 369,101 samples were included, all of which were retrospective cohort studies. 3 studies were of high quality and 18 studies were of moderate quality. The results showed that the prevalence of preoperative anemia was 22% in patients awaiting arthroplasty; subgroup analyses revealed that the prevalence of preoperative anemia was highest in patients awaiting revision of total knee arthroplasty; the highest prevalence of preoperative anemia was found in the Americas; preoperative anemia was more prevalent in the female than in the male population; and preoperative anemia with a history of preoperative anemia was more common in the female than in the male population. patients with a history of preoperative anemia; patients with joint replacement who had a history of preoperative anemia had an increased risk of infection, postoperative blood transfusion rate, postoperative blood transfusion, Deep vein thrombosis of the lower limbs, days in hospital, readmission within three months, and mortality compared with patients who did not have preoperative anemia.
    CONCLUSIONS: The prevalence of preoperative anemia in patients awaiting total joint arthroplasty is 22%, and is higher in TKA and female patients undergoing revision, while preoperative anemia is detrimental to the patient\'s postoperative recovery and will increase the risk of postoperative complications, transfusion rates, days in the hospital, readmission rates, and mortality.
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  • 文章类型: Journal Article
    进行了这项全面审查,以评估氨甲环酸(TXA)对失血的影响,静脉血栓栓塞(VTE)风险,全髋关节置换术(THA)后的伤口并发症。此外,它试图评估各种TXA剂量的效果,管理模式,以及与其他抗纤维蛋白溶解药物的组合。
    在THA患者中使用TXA的系统评价和荟萃分析中,我们通过包括Scopus在内的数据库进行了广泛的搜索,Cochrane图书馆,Embase,Medline,WebofScience,PubMed,谷歌学者。我们发现了23项荟萃分析,涵盖了32,442名患者,这些患者符合我们的研究标准,从这些数据库的创建到2023年5月。
    这篇综合综述的荟萃分析,总共检查了超过35,000名患者,反复证明在THA期间给予TXA如何成功降低围手术期失血量和输血需求。TXA减少总失血量平均151-370毫升,术后血红蛋白水平0.5-1.1g/dL,与对照组相比,输血率平均为19-26%。收集的信息并未表明使用TXA显着增加了VTE或伤口并发症的风险。当比较不同的TXA剂量时,管理技术,或与其他抗纤维蛋白溶解疗法结合使用,在疗效或安全性结局方面没有发现明显差异.
    全面审查清楚地表明,TXA通过降低失血量和输血需求,在不增加不良事件风险的情况下改善了THA结果。这些有见地的信息可以帮助外科医生决定在THA手术期间是否使用TXA。
    UNASSIGNED: This comprehensive review was conducted to assess the effects of tranexamic acid (TXA) on blood loss, venous thromboembolism (VTE) risk, and wound complications following total hip arthroplasty (THA). Additionally, it sought to evaluate the effects of various TXA dosages, modes of administration, and combinations with other antifibrinolytic drug.
    UNASSIGNED: In search of systematic reviews and meta-analyses on the use of TXA in THA patients, we searched extensively through databases including Scopus, the Cochrane Library, Embase, Medline, the Web of Science, PubMed, and Google Scholar. We discovered 23 meta-analyses covering 32,442 patients overall that fulfilled our study criteria, spanning the period from the creation of these databases until May 2023.
    UNASSIGNED: This comprehensive review\'s meta-analyses, which together examined over 35,000 patients, repeatedly demonstrated how TXA administration during THA successfully lowers perioperative blood loss and the need for transfusions. TXA reduced total blood loss by an average of 151-370 ml, postoperative hemoglobin levels by 0.5-1.1 g/dL, and transfusion rates by 19-26% on average when compared to control groups. The information gathered did not indicate that using TXA significantly increased the risk of VTE or wound complications. When comparing different TXA doses, administration techniques, or its use in conjunction with other anti-fibrinolytic therapies, no discernible differences were found in terms of efficacy or safety outcomes.
    UNASSIGNED: The comprehensive review clearly indicates that TXA improves THA outcomes without increasing the risk of adverse events by lowering blood loss and the requirement for transfusions. This insightful information can help surgeons decide whether to use TXA during THA procedures.
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  • 文章类型: Case Reports
    使用内衬的双极半髋关节置换术中的陶瓷头骨折尚未报道,并且似乎没有报告在全髋关节置换术中同时破坏第四代BIOLOXDelta陶瓷头和衬垫。
    一名44岁男性患者3年9个月前因股骨头坏死(ONFH)使用第三代BIOLOXForte陶瓷头行双极人工股骨头置换术,并因陶瓷头骨折到我院就诊。行转换全髋关节置换术。一名64岁的女性患者使用第四代BIOLOXDelta陶瓷头和衬垫关节进行了全髋关节置换术,以治疗髋关节骨关节炎。陶瓷头和衬垫在第三次位错期间断裂。进行了陶瓷头和衬垫交换翻修手术。
    使用陶瓷轴承时,创伤后可能发生骨折或分层,确认需要仔细评估有症状患者的陶瓷组件的状况。
    UNASSIGNED: A fracture of the ceramic head in bipolar hemiarthroplasty using an inner polyliner has not been reported yet, and there seems to be no report of simultaneous breakage of the fourth-generation BIOLOX Delta ceramic head and liner in total hip arthroplasty.
    UNASSIGNED: A 44-year-old male patient underwent bipolar hemiarthroplasty using a third-generation BIOLOX Forte ceramic head 3 years and 9 months earlier for osteonecrosis of femoral head (ONFH) and visited our hospital due to a ceramic head fracture. Conversion total hip arthroplasty was performed. A 64-year-old female patient underwent total hip arthroplasty using a fourth-generation BIOLOX Delta ceramic head and liner articulation for osteoarthritis of the hip. The ceramic head and liner were fractured during the third dislocation. Ceramic head and liner exchange revision surgery was performed.
    UNASSIGNED: When using ceramic bearings, fractures or delamination following trauma can occur, confirming the need to carefully evaluate the condition of the ceramic components in symptomatic patients.
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  • 文章类型: Journal Article
    假体周围关节感染(PJI)对许多接受关节成形术的患者构成了具有挑战性的并发症,文献确定了许多风险因素。全面了解PJI的主要风险和保护因素对外科医生很有价值。本文旨在汇编和总结文献中记录的PJI的关键风险因素。一些危险因素与患者的营养状况有关,肥胖,减肥,维生素缺乏症,经常报告营养不良。影响患者的病理也会导致PJI风险,包括化脓性关节炎,肝炎,糖尿病,尿路感染,贫血,甲状腺功能减退,骨质疏松,和牙病。不健康的习惯,例如烟草和药物滥用,是重要因素。以前的皮质类固醇注射也可能在感染发展中起作用。文献中还报道了一些保护因素(他汀类药物的使用,术前脱色,和入院前皮肤准备)。危险因素的识别和基于证据的术前方案的实施是降低PJI发生率的重要步骤。
    Periprosthetic joint infection (PJI) poses a challenging complication for many patients undergoing arthroplasty, and the literature identifies numerous risk factors. A comprehensive understanding of the primary risk and protective factors for PJI is valuable for surgeons. This article aims to compile and summarize the key risk factors for PJI documented in the literature. Some risk factors are related to the nutritional status of patients, with obesity, weight loss, hypovitaminosis, and malnutrition being frequently reported. Pathologies affecting patients also contribute to PJI risk, including septic arthritis, hepatitis, diabetes, urinary tract infections, anemia, hypothyroidism, osteoporosis, and dental pathologies. Unhealthy habits, such as tobacco and drug abuse, are significant factors. Previous corticosteroid injections may also play a role in infection development. A few protective factors are also reported in the literature (use of statins, preoperative decolonization, and preadmission skin preparation). The identification of risk factors and the implementation of evidence-based preoperative protocols are essential steps in reducing the incidence of PJI.
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  • 文章类型: Journal Article
    这篇综述的目的是识别和综合最重要的文献,解决改变HC对足球队表现的影响,确定最常研究的结果并描述他们的方法。对PubMed的系统评价,Scopus,WebofScience和SPORTDiscus数据库是根据系统评价和荟萃分析的首选报告项目(PRISMA,2020)指导方针。在标题中以各种组合输入了以下关键字和同义词,摘要或关键字:\"足球*\"或足球和\"教练*\"或\"经理*\"和\"替换\"或\"营业额\"或\"替换*\"或\"更改\"。仅包括用英语撰写的原始文章,其中包含有关HC变化对职业男子足球表现的影响的数据。总共确定了94个标题,其中24人符合资格标准。研究的质量被认为是极好的。最常见的分析主题是HC对比赛结果的影响(即,赢了,draw,损失,积分获胜,目标平均值)。一些研究表明,HCs解雇对团队的短期表现有很小但积极的影响,而其他研究结果表明,HC离开后几乎没有影响。解雇HC并不能保证提高表现不佳的团队的成功。一些研究表明,聘请合适的教练可以在短期内对比赛表现产生积极影响。由于研究设计的变化有限,在得出可靠的结论之前,还需要进一步的研究。
    The aim of this review was to identify and synthesise the most significant literature addressing the effects of changing the HC on soccer team\'s performance, identifying the most frequently researched outcomes and characterizing their methodologies. A systematic review of PubMed, Scopus, Web of Science and SPORTDiscus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2020) guidelines. The following keywords and synonyms were entered in various combinations in the title, abstract or keywords: \"football*\" OR soccer AND \"coach*\" OR \"manager*\" AND \"replacement\" OR \"turnover\" OR \"substitution*\" OR \"change\". Solely original articles written in English that contained data about the effects of the change in the HC on performance in professional male soccer were included. A total of 94 titles were identified, of which 24 met the eligibility criteria. The quality of the studies was considered excellent. The most common topic of analysis was the effects of the HC on match outcomes (i.e., win, draw, loss, points won, goals average). Some studies suggest that the HCs dismissal has small but positive impacts on a team\'s short-term performance, while other findings suggest that little-to-no impact is observed following HC departure. The dismissal of the HC does not guarantee increase success of an underperforming team. Some studies suggest that hiring an appropriate coach could positively affect match performance in the short-term. Due to limited variations in study designs, further research is needed before robust conclusions can be drawn.
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  • 文章类型: Journal Article
    随着医学领域研究和开发的进展,使用动物进行药物功效和安全性测试的实验正在增加。每年,数百万只动物被用于实验测试,在此期间这些动物遭受疼痛,然后最终被处死。除了生物伦理问题,动物实验与许多缺点有关,例如高成本,熟练人力的要求,批准,而且很耗时。因此,研究人员已经尝试设计和开发许多可以绕过动物实验的替代方法。这些方法不仅提供准确的结果,而且每年还可以挽救数百万动物的生命。研究技术,包括计算机和机器人技术以及分子生物学技术,用于发现替代动物试验的新方法。本文讨论了几种替代方法。这些方法中的一些可以准确地预测药物的行为,并且与体内动物模型一样可靠。此外,与实验动物相比,这些替代方法具有多种优势。然而,仍然非常需要发现和开发新的,准确,和替代实验动物的可靠方法。
    With an increase in the progression of research and development in the medical field, the experimental use of animals for the efficacy and safety testing of pharmaceuticals is on rise. Every year, millions of animals are used for experimental testing during which these suffer from pain and are then eventually sacrificed. Besides bioethical issues, animal experimentation is associated with many disadvantages like high cost, the requirement of skilled manpower, approval, and is time-consuming. Therefore, attempts have been made by researchers to design and develop a number of alternative methods that could bypass animal experiments. These methods not only give accurate results but can also save lives of millions of animals annually. Research techniques, including computer and robotics together with molecular biology techniques, are applied to discover new methods to replace animal testing. Several alternative methods are discussed in this review. Some of these methods can predict the behavior of drugs accurately and are as reliable as in-vivo animal models. Furthermore, these alternative methods offer a variety of advantages over experimental animals. However, there is still a great need to discover and develop new, accurate, and reliable methods to replace experimental animals.
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  • 文章类型: Journal Article
    BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a viable alternative to total knee arthroplasty (TKA) for osteoarthritis patients with single-compartment involvement, with advantages including accelerated recovery, reduced pain, and improved function. Robotic-assisted UKA (rUKA) is a promising development that ensures precise implant positioning and limb alignment. However, concerns about complications remain.
    OBJECTIVE: This study looks at patient satisfaction as a key metric for determining the efficacy of rUKA versus manual UKA (mUKA).
    METHODS: The search strategy for this study followed PRISMA. Using precise keywords, PubMed, Scopus, Web of Science, and the Cochrane library were searched. English articles were searched until August 2, 2023. Selection criteria included mUKA and rUKA patient satisfaction studies. The NOS scale evaluated study quality. Meta-analysis was done with R and heterogeneity analysis.
    RESULTS: This systematic review examined 5 studies with 1060 UKAs (532 robotic-assisted and 528 manual). Variable satisfaction assessment methods were used. Three studies found no difference in patient satisfaction after robotic-assisted UKA, but two found a higher satisfaction. Meta-analysis showed robotic-assisted UKA improved patient satisfaction (OR = 1.72 [1.25-2.37]). Overall, most studies showed low risk of bias, except one with higher bias.
    CONCLUSIONS: This review suggests that robotic assistance may enhance patient satisfaction in UKA procedures.
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