preferences

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  • 文章类型: Journal Article
    效用值提供了一种定量方法来评估新型癌症治疗对患者生活质量(QoL)的影响。然而,可用于评估QoL的多种方法在不同上下文中选择最合适的方法时面临挑战。
    这篇综述为癌症临床医生和研究人员提供了评估QoL的经济评估方法的概述,包括独立和派生的基于偏好的度量(PBMs)和直接偏好激发方法。描述了最近的事态发展,包括癌症特异性PBM与通用PBM的比较性能,超出健康相关QoL的结果测量,并更多地使用离散选择实验来引出偏好。提供了建议和注意事项,以指导癌症研究方法的选择。
    鉴于EORTCQLQ-C30和FACT-G在癌症研究中的广泛使用,我们预计将继续在癌症临床试验中采用QLU-C10D和FACT-8D。虽然这些癌症特异性PBM提供了在不需要独立PBM的情况下获取效用值的便利,研究人员应该考虑潜在的限制,如果他们打算用通用PBM代替它们。随着领域的发展,更需要就癌症临床试验中各种方法的选择和整合方法达成共识.
    UNASSIGNED: Utility values offer a quantitative means to evaluate the impact of novel cancer treatments on patients\' quality of life (QoL). However, the multiple methods available for valuing QoL present challenges in selecting the most appropriate method across different contexts.
    UNASSIGNED: This review provides cancer clinicians and researchers with an overview of methods to value QoL for economic evaluations, including standalone and derived preference-based measures (PBMs) and direct preference elicitation methods. Recent developments are described, including the comparative performance of cancer-specific PBMs versus generic PBMs, measurement of outcomes beyond health-related QoL, and increased use of discrete choice experiments to elicit preferences. Recommendations and considerations are provided to guide the choice of method for cancer research.
    UNASSIGNED: We foresee continued adoption of the QLU-C10D and FACT-8D in cancer clinical trials given the extensive use of the EORTC QLQ-C30 and FACT-G in cancer research. While these cancer-specific PBMs offer the convenience of eliciting utility values without needing a standalone PBM, researchers should consider potential limitations if they intend to substitute them for generic PBMs. As the field advances, there is a greater need for consensus on the approach to selection and integration of various methods in cancer clinical trials.
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  • 文章类型: Journal Article
    背景:全基因组测序(WGS)对血癌管理具有转化潜力,但报销受到相对于额外成本的不确定收益的阻碍。本研究采用情景规划和多准则决策分析(MCDA)来评估利益相关者对替代报销途径的偏好,告知未来健康技术评估(HTA)提交的WGS在血癌中的应用。
    方法:通过文献检索确定了影响血液癌症WGS报销的关键因素。使用形态学方法开发了描述HTA的WGS各种证据特征的假设方案。网上调查,结合MCDA重量,旨在收集利益相关者的偏好(消费者/患者,临床医生/卫生专业人员,行业代表,健康经济学家,和HTA委员会成员)对于这些情况。调查评估了参与者对每种情况下WGS报销的批准,场景偏好是使用几何平均方法确定的,应用算法通过解决不一致的响应来提高可靠性和精度。
    结果:19名参与者提供了完整的调查答复,主要是临床医生或卫生专业人员(n=6;32%),消费者/患者和行业代表(均为n=5;26%)。“WGS结果对患者护理的临床影响”是最关键的标准(标准权重为0.25),其次是“WGS的诊断准确性”(0.21),“WGS的成本效益”(0.19),“WGS后报销治疗的可用性”(0.16),和“基于可操作的WGS结果的报销治疗资格标准”和“WGS成本比较”(均为0.09)。参与者更喜欢有大量临床证据的场景,获得报销的有针对性的治疗,成本效益低于每质量调整生命年(QALY)50,000美元,和相对于标准分子测试的可负担性。最初反对补偿,直到达到标准测试的同等成本和更好的治疗可及性等标准。
    结论:付款人通常强调可接受的成本效益,但许多变种的强有力的临床证据和与标准测试相当的成本可能会推动WGS的积极报销决定.
    BACKGROUND: Whole genome sequencing (WGS) has transformative potential for blood cancer management, but reimbursement is hindered by uncertain benefits relative to added costs. This study employed scenario planning and multi-criteria decision analysis (MCDA) to evaluate stakeholders\' preferences for alternative reimbursement pathways, informing future health technology assessment (HTA) submission of WGS in blood cancer.
    METHODS: Key factors influencing WGS reimbursement in blood cancers were identified through a literature search. Hypothetical scenarios describing various evidential characteristics of WGS for HTA were developed using the morphological approach. An online survey, incorporating MCDA weights, was designed to gather stakeholder preferences (consumers/patients, clinicians/health professionals, industry representatives, health economists, and HTA committee members) for these scenarios. The survey assessed participants\' approval of WGS reimbursement for each scenario, and scenario preferences were determined using the geometric mean method, applying an algorithm to improve reliability and precision by addressing inconsistent responses.
    RESULTS: Nineteen participants provided complete survey responses, primarily clinicians or health professionals (n = 6; 32 %), consumers/patients and industry representatives (both at n = 5; 26 %). \"Clinical impact of WGS results on patient care\" was the most critical criterion (criteria weight of 0.25), followed by \"diagnostic accuracy of WGS\" (0.21), \"cost-effectiveness of WGS\" (0.19), \"availability of reimbursed treatment after WGS\" (0.16), and \"eligibility criteria for reimbursed treatment based on actionable WGS results\" and \"cost comparison of WGS\" (both at 0.09). Participants preferred a scenario with substantial clinical evidence, high access to reimbursed targeted treatment, cost-effectiveness below $50,000 per quality-adjusted life year (QALY) gained, and affordability relative to standard molecular tests. Reimbursement was initially opposed until criteria such as equal cost to standard tests and better treatment accessibility were met.
    CONCLUSIONS: Payers commonly emphasize acceptable cost-effectiveness, but strong clinical evidence for many variants and comparable costs to standard tests are likely to drive positive reimbursement decisions for WGS.
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  • 文章类型: Journal Article
    背景:考虑尝试戒烟的个人的价值观和偏好是戒烟技术发展的关键一步。本研究旨在探讨有关智能戒烟技术的偏好。
    方法:该平行会聚混合方法研究分两个阶段进行:定量和定性。在定量阶段,一项横断面研究是通过分层随机抽样从大不里士基于技术的戒烟诊所选择的360名参与者进行的,德黑兰,和伊朗的卡拉杰城市。使用问卷调查收集有关人口统计学特征和对智能戒烟技术的偏好的数据,并使用描述性统计进行分析。在定性阶段,通过有目的和滚雪球采样选择了25个这些技术的用户。数据是通过深入的半结构化访谈收集的,并使用定性内容分析和常规方法进行分析。使用合并策略和融合模型整合定量和定性数据。
    结果:定量阶段结果表明,最高偏好与佩戴和使用智能手表戒烟以及使用移动应用程序有关。在定性阶段,提取了17个子类别,并分为8个主要类别:高效,更好地管理戒烟过程,个性化技术,安全和简单的技术,吸引力和创新设计,科学依据,移动应用程序,和智能监控设备。
    结论:通过结合和整合定量和定性结果,可以得出结论,用户对可穿戴技术和交互式移动应用更感兴趣。这项研究的结果可以帮助戒烟技术开发人员根据用户的需求和偏好设计和改进他们的工具,以提高他们的有效性和可接受性。
    BACKGROUND: Considering the values and preferences of individuals who attempt to quit smoking is a crucial step in the development of smoking cessation technologies. This study aimed to explore preferences regarding smart smoking cessation technologies.
    METHODS: This parallel convergent mixed-methods study was conducted in two phases: quantitative and qualitative. In the quantitative phase, a cross-sectional study was conducted with 360 participants selected through stratified random sampling from technology-based smoking cessation clinics in Tabriz, Tehran, and Karaj cities in Iran. Data on demographic characteristics and preferences for smart smoking cessation technologies were collected using questionnaires and analyzed using descriptive statistics. In the qualitative phase, 25 users of these technologies were selected through purposeful and snowball sampling. The data were gathered through in-depth semistructured interviews and analyzed using qualitative content analysis with a conventional approach. Quantitative and qualitative data were integrated using the merging strategy and convergence model.
    RESULTS: The quantitative phase results indicated that the highest preference was related to wearing and using a smartwatch for smoking cessation and using mobile apps. In the qualitative phase, 17 subcategories were extracted and classified into 8 main categories: high effectiveness, better management of the smoking cessation process, personalized technology, safe and uncomplicated technologies, attractiveness and innovative design, scientific basis, mobile applications, and smart monitoring devices.
    CONCLUSIONS: By combining and integrating quantitative and qualitative results, it can be concluded that users are more interested in wearable technologies and interactive mobile applications. The findings of this study can assist smoking cessation technology developers in designing and improving their tools based on user needs and preferences to enhance their effectiveness and acceptability.
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  • 文章类型: Journal Article
    数字健康技术干预措施在增强患有人类免疫缺陷病毒(ALHIV)的青少年的自我管理实践方面显示出希望。这项范围审查的目的是确定低收入和中等收入国家(LMICs)中ALHIV对使用数字卫生技术进行慢性病自我管理的偏好。电子数据库,包括PubMed,护理和相关健康文献累积指数(CINAHL)(加全文),中央(科克伦图书馆),认识论,和Medline(EbscoHost),被搜查了。该评论的重点是2023年6月之前发表的英文文章,这些文章描述了LMIC对ALHIV的技术干预。筛选和数据提取工具Covidence促进了范围审查过程。在413项研究中,10人被纳入审查。数字健康技术干预措施可以提供增强的支持,教育,以及LMICs中ALHIV的赋权。然而,障碍,如有限的访问,污名,必须解决隐私问题。根据当地情况量身定制干预措施并将技术集成到医疗保健系统中可以优化其有效性。审查注册:OSF注册(https://archive.org/details/osf-registrations-eh3jz-v1)。
    Digital health technology interventions have shown promise in enhancing self-management practices among adolescents living with Human Immunodeficiency Virus (ALHIV). The objective of this scoping review was to identify the preferences of ALHIV in low- and middle-income countries (LMICs) concerning the use of digital health technology for the self-management of their chronic illness. Electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Plus with Full Text), Central (Cochrane Library), Epistemonikos, and Medline (EbscoHost), were searched. The review focused on English articles published before June 2023, that described a technology intervention for ALHIV specifically from LMIC. The screening and data extraction tool Covidence facilitated the scoping review process. Of the 413 studies identified, 10 were included in the review. Digital health technology interventions can offer enhanced support, education, and empowerment for ALHIV in LMICs. However, barriers like limited access, stigma, and privacy concerns must be addressed. Tailoring interventions to local contexts and integrating technology into healthcare systems can optimize their effectiveness.Review registration: OSF REGISTRIES (https://archive.org/details/osf-registrations-eh3jz-v1).
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  • 文章类型: Journal Article
    目的:这项研究的目的是在讲法语的魁北克成年人群中引起对2019年冠状病毒病(COVID-19)疫苗活动的偏好,并强调疫苗活动的特点。
    方法:2021年4月至6月在魁北克进行了离散选择实验(DCE),加拿大。按年龄划分的配额抽样方法,性别和教育水平被用来获得法语成人人口的代表性样本。基于选择的练习由疫苗活动场景中的七个属性描述。使用混合logit(MXL)模型和潜在类logit(LCL)模型来得出效用值。年龄,性别,教育水平,收入和对COVID-19的恐惧作为自变量纳入LCL。
    结果:共包括1883名受访者进行分析,产生22,586个选择。从这些选择中,3425(15.16%)被拒绝。此外,1159(61.55%)个人始终接受任何疫苗接种运动,而92人(4.89%)总是拒绝疫苗替代品。根据MXL,属性的相对权重重要性是有效性(32.50%),副作用风险(24.76%),科学证据水平(22.51%),拍摄次数(15.73%),优先人群(3.60%),疫苗类型(0.61%),和接种地点(0.28%)。从LCL模型中导出了四个类,根据它们,属性或多或少是重要的。1级(19.8%)更关注效果(27.99%),安全性(24.22%)和射击次数(21.82%),2类(55.3%)想要高效疫苗(40.16%),3类(17.6%)对科学证据给予了很高的价值(42.00%).4类偏好(7.4%)更加平衡,每个属性的相对重量范围为1.84%(疫苗类型)至21.32%(副作用风险)。发现潜在类别的成员资格后验概率是由性别等个人因素预测的,年收入或对COVID-19的恐惧。
    结论:疫苗接种的接受依赖于多种因素。这项研究允许通过基于选择的练习来评估疫苗接种特异性问题,并通过分割样本和绘制个体概况来描述影响这种选择的因素。此外,除了有效性和安全性,这项研究的一个主要观点是表明普通人群对疫苗相关科学证据水平的重要性。
    一小群公民参与了这个概念,数据的设计和解释。DCE的参与者均来自普通人群。
    OBJECTIVE: The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance.
    METHODS: A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL.
    RESULTS: A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19.
    CONCLUSIONS: Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines.
    UNASSIGNED: A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.
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  • 文章类型: Journal Article
    关于向非洲的研究参与者披露基因组结果的政策和研究很少。由于了解参与者的偏好对于反馈过程的成功至关重要,本研究通过与正在进行的神经发育障碍基因组学研究项目的参与者进行接触来解决这一问题,目的是评估接收相关结果的预期影响,并探索南非背景下的反馈偏好.对参与研究的17名儿童父母进行了12次半结构化访谈。使用主题分析和框架矩阵分析了转录的访谈数据和观察笔记。参与者将自己的含义与接收相关结果的影响联系起来,并认为这些信息不仅出于临床效用的原因而有用。这些包括关闭,改善对孩子病情和复发风险信息的管理。在对反馈的偏好方面,面对面的结果传递会议,由研究小组成员或熟悉孩子的医学专业人员进行的研究是首选。此外,参与者对自己的血液或对研究的贡献感到一种主人翁感,即使在不相关的结果中也能找到意义。这些发现提供了对讨论类型的见解,这些讨论可能对制定最佳实践和准则以返回单个遗传研究结果很有价值。以文化上适当的方式,在南非社区。
    Few policies and little research exist regarding the disclosure of genomic results to research participants in Africa. As understanding participant preferences would be pivotal to the success of the feedback process, this study set out to address this issue by engaging with enrolled participants from an ongoing genomics research project on neurodevelopmental disorders with the aim to assess the anticipated impact of receiving pertinent results and explore the preferences for feedback in a South African context. Twelve semi-structured interviews were conducted with 17 parents of children participating in the research study. Transcribed interview data and observational notes were analysed using thematic analysis and framework matrices. Participants linked their own meaning to the impact of receiving a pertinent result and perceived the information as useful for reasons other than only clinical utility. These included closure, improved management of their child\'s condition and information regarding recurrence risks. In terms of preferences for feedback, an in-person result delivery session, conducted by a member of the study team or medical professional familiar with their child was preferred. In addition, participants felt a sense of ownership over their blood or their contribution to the research study, finding meaning even in non-pertinent results. These findings provide insight into the type of discussions that may be valuable in enabling the development of best practices and guidelines for the return of individual genetic research results, in a culturally appropriate manner, within South African communities.
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  • 文章类型: Journal Article
    高质量的陈述偏好(SP)调查的开发需要严格的设计过程,涉及目标人群的代表参与。然而,虽然鼓励报告SP调查发展的透明度,很少有研究报告这一过程和结果。仪器开发的推荐阶段包括利益相关者/最终用户参与和预测试两个步骤。前测通常包括面试,经常跨越多个波浪,在每一波都有改进;因此,预测试是资源密集型的。本文的目的是报告在SP调查的设计阶段与路易体痴呆症研究咨询小组合作的结果。我们还评估了仪器开发的替代方法,资源受限的环境所必需的。
    该方法涉及在公众参与活动期间进行最终用户参与和预先测试的阶段。采用了一种混合方法,该方法涉及一个具有突破性访谈的焦点小组。来自贡献者的反馈告知了调查工具的演变。
    对测量工具的更改分为四类:属性修改;选择任务的演示和理解;信息演示,清晰度和内容;以及最佳-最佳缩放演示。混合方法促进了小组头脑风暴,同时仍允许研究人员在面试环境中评估选择任务的可行性。然而,通过这种方法,更多的个体探索和尝试跨波迭代改进的机会是不可行的.
    研究咨询小组的参与导致了更加以人为本的调查设计。在受时间和预算限制的情况下,并考虑到目标人群的能力和脆弱性,所采取的方法是改进SP调查设计的可行和务实的机制。
    UNASSIGNED: The development of high-quality stated preference (SP) surveys requires a rigorous design process involving engagement with representatives from the target population. However, while transparency in the reporting of the development of SP surveys is encouraged, few studies report on this process and the outcomes. Recommended stages of instrument development includes both steps for stakeholder/end-user engagement and pretesting. Pretesting typically involves interviews, often across multiple waves, with improvements made at each wave; pretesting is therefore resource intensive. The aims of this paper are to report on the outcomes of collaboration with a Lewy body dementia research advisory group during the design phase of a SP survey. We also evaluate an alternative approach to instrument development, necessitated by a resource constrained context.
    UNASSIGNED: The approach involved conducting the stages of end-user engagement and pretesting together during a public involvement event. A hybrid approach involving a focus group with breakout interviews was employed. Feedback from contributors informed the evolution of the survey instrument.
    UNASSIGNED: Changes to the survey instrument were organized into four categories: attribute modifications; choice task presentation and understanding; information presentation, clarity and content; and best-best scaling presentation. The hybrid approach facilitated group brainstorming while still allowing the researcher to assess the feasibility of choice tasks in an interview setting. However, greater individual exploration and the opportunity to trial iterative improvements across waves was not feasible with this approach.
    UNASSIGNED: Involvement of the research advisory group resulted in a more person-centered survey design. In a context constrained by time and budget, and with consideration of the capacity and vulnerability of the target population, the approach taken was a feasible and pragmatic mechanism for improving the design of a SP survey.
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  • 文章类型: Journal Article
    背景:神经肌肉阻滞(NMB)药物是平衡麻醉的关键组成部分。NMB逆转方法可以包括自发逆转,sugammadex,或新斯的明和逆转策略的选择可能取决于各种因素。由于COVID-19大流行,临床实践出现了意想不到的变化,更好地了解NMB逆转趋势如何受到大流行的影响,可能有助于深入了解提供者如何看待选择NMB逆转剂的权衡。
    目的:我们旨在分析COVID-19爆发前后美国成人住院手术的NMB逆转剂使用模式,以确定与大流行相关的实践变化是否影响使用趋势。
    方法:对大型全付款人国家电子医疗保健数据库(PINCAIHealthcareDatabase)进行了回顾性纵向分析,以确定早期NMB逆转的使用模式,中间,和晚期COVID-19(EC,MC,LC,分别)时间段。在COVID-19大流行到达美国之前和之后,评估了住院手术中与NMB逆转选择相关的因素。多变量逻辑回归评估了大流行对NMB逆转的影响,为病人考虑,临床,程序,和网站特征。使用反事实框架来了解患者特征是否影响COVID-19时代患者在大流行前的治疗方式。
    结果:在2017年3月1日至2021年12月31日期间,在931个符合所有纳入标准的地点,超过320万住院患者经历了超过360万的外科手术。NMB逆转趋势显示,随着时间的推移,sugammadex的逆转稳步增加,从2018年1月起的趋势与时间呈线性关系(R2>0.99)。多变量分析显示,COVID-19后时间段对趋势影响较小,但具有统计学意义。通过COVID-19时间段的相互作用项和NMB逆转的时间趋势来衡量。相对于COVID-19之前的趋势(比值比[OR]1.008,95%CI1.003-1.014;P=.003),随后是对MC期间增加的否定(OR0.992,95%CI0.987-0.997;P<.001),在LC期间没有发现显著的相互作用(OR1.001,95%CI0.996-1.005;P=0.81)。相反,主动逆转(使用sugamadex或新斯的明)与自发逆转没有显着关联,或者趋势的变化,在EC或MC(P>0.05)期间,尽管在LC期间观察到主动逆转趋势略有下降(OR0.987,95%CI0.983-0.992;P<.001)。
    结论:我们观察到NMB活性逆转总体上呈稳定增长,特别是sugamadex与新斯的明相比,在COVID-19爆发之前和之后的一段时间。小,在COVID-19大流行期间观察到NMB逆转趋势的短暂变化,尽管这些改变与潜在的NMB逆转时间趋势无关。
    BACKGROUND: Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents.
    OBJECTIVE: We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends.
    METHODS: A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19-era patients would have been treated before the pandemic.
    RESULTS: More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post-COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre-COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001).
    CONCLUSIONS: We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends.
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  • 文章类型: Systematic Review
    对降低痴呆风险和早期发现阿尔茨海默病和相关疾病的认识提高了对痴呆风险识别的兴趣,潜在的推定生物学,或者痴呆症本身。实施这些方法需要公众的接受。2012年之前的研究表明,人群痴呆筛查的可接受性有限。痴呆症预防研究的变化可能会影响最近的看法。此外,来自服务不足的人群的观点,如少数民族和低社会经济群体,缺乏。
    在这篇系统综述中,我们寻求自2012年以来发表的关于痴呆症患者态度和偏好的研究,照顾者和来自少数民族和低社会经济群体的公众对痴呆症筛查。
    此评论已在PROSPERO(CRD42023384115)上进行了预注册,并遵循了PRISMA指南。关键搜索项被输入到五个数据库中。如果文章侧重于人群或通过基于初级/社区护理的评估进行痴呆症的风险筛查,其中包括多数少数民族或低社会经济群体,或在数据分析中离散地考虑了这些群体。数据是叙述式合成的。
    七项研究报道了少数民族对痴呆症筛查的看法;一项研究包括来自低社会经济群体的人。结果表明,来自少数民族的参与者愿意接受痴呆症筛查。意愿的预测因素包括对福利的信念,渴望促进多样性,并实施生活方式的改变。不愿意与对结果的焦虑有关。
    尽管在研究组中似乎对筛查具有很高的可接受性,需要更多的研究来探索诸如文化和经济障碍之类的筛查的实际考虑因素,信任,和筛查后的行动。
    UNASSIGNED: Increased understanding of dementia risk-reduction and early detection of Alzheimer\'s disease and related disorders has spurred interest in the identification of risks for dementia, underlying putative biologies, or dementia itself. Implementation of such approaches require acceptability to the public. Research prior to 2012 indicated limited acceptability for population dementia screening. The changing landscape of dementia prevention research may influence recent perceptions. Additionally, perspectives from underserved populations, such as ethnic minorities and low socio-economic groups, are lacking.
    UNASSIGNED: In this systematic review, we sought published studies since 2012 on attitudes and preferences of people with dementia, carers and the general public from ethnic minorities and low socio-economic groups regarding dementia screening.
    UNASSIGNED: This review was preregistered on PROSPERO (CRD42023384115) and followed PRISMA guidelines. Key search terms were entered into five databases. Articles were included if they focused on population or risk screening for dementia via primary/community care-based assessments, and which included majority ethnic minority or low socio-economic groups or discretely considered these groups in data analysis. Data were synthesized narratively.
    UNASSIGNED: Seven studies reported perspectives of ethnic minorities regarding dementia screening; one study included people from low socio-economic groups. Results indicated that participants from ethnic minorities were willing to undergo dementia screening. Predictors of willingness included belief in benefits, desire to boost diversity, and to implement lifestyle changes. Unwillingness was associated with anxiety regarding results.
    UNASSIGNED: Although there seems to be high acceptability for screening in the studied groups, more research is necessary to explore the practical considerations for screening such as cultural and economic barriers, trust, and post-screening actions.
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  • 文章类型: Journal Article
    这篇观点论文探讨了物理治疗和数字健康技术(DHT)在增强对囊性纤维化(CF)患者的护理方面的动态交集,在进步的背景下,例如高效的调节剂疗法,可以提高预期寿命和改变理疗需求。DHT的作用,包括远程医疗,监视,家庭监控,和活动推广,扩大了,在克服地理障碍方面变得至关重要,并因最近的大流行而加速。物理治疗,自1946年以来,CF护理不可或缺,已经转向以患者为中心的方法,强调运动训练和身体活跃的生活方式。由于高效的调制疗法,住院人数减少,导致家庭护理和在线或电子咨询增加,DHT彻底改变了服务交付,提供灵活性,自我管理,和个性化的护理选择;然而,需要全面了解CF患者和物理治疗师的用户体验。本文重点介绍了用户体验的基本探索,以促进临床医生适应现代临床管理的数字化要求,确保“未来医院”领域的公平护理。找出研究差距,本文强调需要全面评估DHT在CF物理治疗教育中的使用,培训,和自我监控,以及CF患者通过在线或电子咨询的经验,自我监控,远程干预。在线小组锻炼平台解决了与感染控制有关的历史挑战,但需要对用户体验和偏好进行全面评估。CF的物理治疗管理中面向未来的DHT需要向完全整合转变,考虑利益相关者的意见并解决障碍。虽然DHT有可能将物理治疗扩展到医院之外,本文强调了理解用户体验的重要性,解决数字贫困,并努力实现更公平的医疗保健。提倡在“未来医院”中采取灵活的方法,强调需要对用户偏好和体验进行细致入微的理解,以优化DHT在CF护理中的集成。
    UNASSIGNED: This viewpoint paper explores the dynamic intersection of physiotherapy and digital health technologies (DHTs) in enhancing the care of people with cystic fibrosis (CF), in the context of advancements such as highly effective modulator therapies that are enhancing life expectancy and altering physiotherapy needs. The role of DHTs, including telehealth, surveillance, home monitoring, and activity promotion, has expanded, becoming crucial in overcoming geographical barriers and accelerated by the recent pandemic. Physiotherapy, integral to CF care since 1946, has shifted toward patient-centered approaches, emphasizing exercise training and a physically active lifestyle. The reduction in inpatient admissions due to highly effective modulator therapies has led to increased home care and online or electronic consultations, and DHTs have revolutionized service delivery, offering flexibility, self-management, and personalized care options; however, there is a need to comprehensively understand user experiences from both people with CF and physiotherapists. This paper highlights the essential exploration of user experiences to facilitate clinician adaptation to the digital requirements of modern clinical management, ensuring equitable care in the \"future hospitals\" arena. Identifying research gaps, this paper emphasizes the need for a thorough evaluation of DHT use in CF physiotherapy education, training, and self-monitoring, as well as the experiences of people with CF with online or electronic consultations, self-monitoring, and remote interventions. Online group exercise platforms address historical challenges relating to infection control but necessitate comprehensive evaluations of user experiences and preferences. Future-proofing DHTs within the physiotherapy management of CF demands a shift toward full integration, considering stakeholder opinions and addressing barriers. While DHTs have the potential to extend physiotherapy beyond the hospital, this paper stresses the importance of understanding user experiences, addressing digital poverty, and working toward more equitable health care access. A flexible approach in the \"future hospital\" is advocated, emphasizing the need for a nuanced understanding of user preferences and experiences to optimize the integration of DHTs in CF care.
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