我国医疗技术管理中引入医疗技术评估的路径探讨

2015年以来,在简政放权的大环境下,我国医疗技术管理面临着从重审批的分级分类管理向重监管转型的挑战和机遇,亟需探索建立更加科学合理的医疗技术管理体系。使用医疗技术评估的科学工具和手段是在医疗技术管理领域国际通行的理念和做法。本文梳理了我国医疗技术管理政策沿革,介绍了国际典型代表英国医疗技术管理的过程和方法,并为完善我国医疗技术管理提供了几条政策建议。     

慢性阻塞性肺疾病不同表型患者CAT评分与肺功能及预后的相关性分析

摘要 目的：探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）不同表型评估测试问卷（COPD assessment test,CAT）评分与肺功能及预后的关系。方法：收集361例COPD患者临床资料、CAT评分、肺功能检查结果及肺外合并症、肺内并发症等情况,按临床表型分为肺气肿组（n=200）和支气管炎组（n=161）,分析肺气肿组200例和支气管炎组161例COPD患者CAT评分与肺功能及预后的关系。结果：肺气肿组CAT评分高于支气管炎组（P<0.05）,一秒用力呼气容积（FEV₁）占预计值百分比（FEV₁%）、FEV₁/用力肺活量（FVC）低于支气管炎组（P<0.05）,吸气分数（IC/TLC）低于支气管炎组,残总比（RV/TLC）高于支气管炎组（P<0.05）;肺气肿组肺间质性病变、肺动脉高压发生率均高于支气管炎组（P<0.05）;支气管炎、肺气肿组CAT评分均与FEV₁%、FEV₁/FVC、IC/TLC呈负相关（P<0.05）,与RV/TLC呈正相关（P<0.05）,肺气肿各参数相关度更高（P<0.05）;肺气肿组不同CAT评分患者肺间质性病变、肺动脉高压发生率比较差异有统计学意义（P<0.05）,支气管炎组不同CAT评分肺动脉高压发生率比较差异有统计学意义（P<0.05）,随CAT评分的升高,肺气肿组肺间质性病变、肺动脉高压发生率上升,支气管炎组肺动脉高压发生率上升。结论： COPD肺气肿表型CAT评分较支气管炎表型高,肺功能降低更明显,呈现肺过度通气,气流受限特点,更易并发肺间质纤维化、肺动脉高压,且与CAT评分变化密切相关。     

Pond Acoustic Sampling Scheme: A draft protocol for rapid acoustic data collection in small waterbodies

1. Freshwater conservation is vital to the maintenance of global biodiversity. Ponds are a critical, yet often under‐recognized, part of this, contributing to overall ecosystem functioning and diversity. They provide habitats for a range of aquatic, terrestrial, and amphibious life, often including rare and declining species.
2. Effective, rapid, and accessible survey methods are needed to enable evidence‐based conservation action, but freshwater taxa are often viewed as “difficult”—and few specialist surveyors are available. Datasets on ponds are therefore limited in their spatiotemporal coverage.
3. With the advent of new recording technologies, acoustic survey methods are becoming increasingly available to researchers, citizen scientists, and conservation practitioners. They can be an effective and noninvasive approach for gathering data on target species, assemblages, and environmental variables. However, freshwater applications are lagging behind those in terrestrial and marine spheres, and as an emergent method, research studies have employed a multitude of different sampling protocols.
4. We propose the Pond Acoustic Sampling Scheme (PASS), a simple protocol to allow a standardized minimal sample to be collected rapidly from small waterbodies, alongside environmental and methodological metadata. This sampling scheme can be incorporated into a variety of survey designs and is intended to allow access to a wide range of participants, without requiring complicated or prohibitively expensive equipment.
5. Adoption of this sampling protocol would enable consistent sound recordings to be gathered by researchers and conservation organizations, and allow the development of landscape‐scale surveys, data sharing, and collaboration within an expanding freshwater ecoacoustic community—rather than individual approaches that produce incompatible datasets. The compilation of standardized data would improve the prospects for effective research into the soundscapes of small waterbodies and aid freshwater conservation efforts.

     

Strategies for rapid assessment of fungal diversity

The problems of estimating fungal diversity are considerable, due especially to the large numbers of species even in small study sites, only a small proportion of which are adequately characterized, and the lack of trained staff and appropriate identification manuals. These difficulties are multiplied in the tropics. Strategies for providing preliminary assessments of fungal diversity which can be carried out within short time-frames are discussed, which will allow initial site valuations to be made for conservation purposes. The necessity of identifying all species discovered is considered, and the need emphasized for strictly defined sampling protocols which allow proper comparison between sites. The advantages and disadvantages of preliminary diversity analyses involving different taxonomic and ecological groups, fungus/plant associations, spatial sampling, soil and litter analysis, molecular methods and indirect assessment are considered.     

Patch assessment in foraging flocks of European starlings: evidence for the use of public information

A field experiment was carried out to determine whether group-foragingstarlings (Sturnus vulgaris) use public information to helpthem estimate the quality of an artificial resource patch anddepart accordingly. Three kinds of information are potentiallyavailable in a group: patch-sample information, pre-harvestinformation, and public information. These three types of informationcan be combined into four patch assessment strategies: (1) patch-samplealone; (2) patch-sample and pre-harvest; (3) patch-sample andpublic; and (4) patch-sample, pre-harvest, and public. Dependingon the foraging environment we presented to the starlings, eachassessment strategy made a unique set of predictions concerningthe patch departure decisions of pairs of birds based on differencesin their foraging success. The environment was manipulated intwo ways: by altering the variability in patch quality and bychanging compatibility, the ease with which individual birdscould simultaneously acquire both patch-sample and public information.Our observations on patch persistence and departure order demonstratethat the starlings used a combination of patch-sample and publicinformation, but not pre-harvest information, to estimate thequality of the experimental patch. Moreover, our results suggestthat starlings use public information only when it is easilyavailable and ignore it under incompatible conditions. Thisstudy provides the first evidence of public information usein a patch assessment problem.     

Contact sensitization: A new approach to risk assessment

The murine local lymph node assay is a novel predictive test for the identification of skin sensitizing chemicals. The method measures sensitization potential of a chemical in mice as a function of proliferative activity induced in lymph nodes draining the site of topical exposure to that test chemical. Here we describe the use of the local lymph node assay for evaluation of the relative potency of skin sensitizing chemicals via derivation of the concentration required to produce a threshold positive reaction. Subsequently, the development of risk assessments based on comparisons with index contact allergens is outlined.     

Analysis of Alkylphenol ethoxylates (APEOs) from tannery sediments using LC–MS and their environmental risks

Alkyl phenol polyethoxylates (APEOs) are a major group of high production volume chemicals, extensively used as nonionic surfactants in industrial, agricultural and domestic sectors. These surfactants and its respective metabolites are found to be persistent and toxic. Mainly, they act as endocrine disruptors by mimicking the natural hormones. India being a developing country, witnesses pollution due to various industries including tannery. In the present study, sediment samples were collected from the Vellore district of Tamil Nadu, India to investigate the occurrence of APEOs. The sediments were extracted by ultrasonication and analyzed in a liquid chromatography mass spectrometer. Octyl phenol ethoxylates (OPEOs) were not observed in any of the samples. Nonyl phenol ethoxylates (NPEOs) were detected in the range of ND – 36 mg/kg with 85 % detection frequency. The occurrence of NPEOs in sediment indicates its wide usage in tannery and its partitioning behavior in environment. The levels of NPEOs in the study were found to be unsafe according to the sediment guidelines of various studies. Since NPEOs were observed in sediment samples, possibilities of occurrence of their monomers and metabolites cannot be ruled out. Therefore, further studies are warranted for understanding the levels of monomers and metabolites in order to ascertain the environmental risks more appropriately.     

Life cycle assessment of emerging technologies at the lab scale: The case of nanowire‐based solar cells

Nanomaterials are expected to play an important role in the development of sustainable products. The use of nanomaterials in solar cells has the potential to increase their conversion efficiency. In this study, we performed a life cycle assessment (LCA) for an emerging nanowire‐based solar technology. Two lab‐scale manufacturing routes for the production of nanowire‐based solar cells have been compared—the direct growth of GaInP nanowires on silicon substrate and the growth of InP nanowires on native substrate, peel off, and transfer to silicon substrate. The analysis revealed critical raw materials and processes of the current lab‐scale manufacturing routes such as the use of trifluoromethane (CHF₃), gold, and an InP wafer and a stamp, which are used and discarded. The environmental performance of the two production routes under different scenarios has been assessed. The scenarios include the use of an alternative process to reduce the gold requirements—electroplating instead of metallization, recovery of gold, and reuse of the InP wafer and the stamp. A number of suggestions, based on the LCA results—including minimization of the use of gold and further exploration for upscaling of the electroplating process, the increase in the lifetimes of the wafer and the stamp, and the use of fluorine‐free etching materials—have been communicated to the researchers in order to improve the environmental performance of the technology. Finally, the usefulness and limitations of lab‐scale LCA as a tool to guide the sustainable development of emerging technologies are discussed.     

Lifting the veil on the correction of double counting incidents in hybrid life cycle assessment

Life cycle assessment (LCA) and environmentally extended input–output analyses (EEIOA) are two techniques commonly used to assess environmental impacts of an activity/product. Their strengths and weaknesses are complementary, and they are thus regularly combined to obtain hybrid LCAs. A number of approaches in hybrid LCA exist, which leads to different results. One of the differences is the method used to ensure that mixed LCA and EEIOA data do not overlap, which is referred to as correction for double counting. This aspect of hybrid LCA is often ignored in reports of hybrid assessments and no comprehensive study has been carried out on it. This article strives to list, compare, and analyze the different existing methods for the correction of double counting. We first harmonize the definitions of the existing correction methods and express them in a common notation, before introducing a streamlined variant. We then compare their respective assumptions and limitations. We discuss the loss of specific information regarding the studied activity/product and the loss of coherent financial representation caused by some of the correction methods. This analysis clarifies which techniques are most applicable to different tasks, from hybridizing individual LCA processes to integrating complete databases. We finally conclude by giving recommendations for future hybrid analyses.