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In recent years, photon-counting computed tomography (PCD-CT) based on photon-counting detectors (PCDs) has become increasingly utilized in clinical practice. Compared with conventional CT, PCD-CT has the potential to achieve micron-level spatial resolution, lower radiation dose, negligible electronic noise, multi-energy imaging, and material identification, etc. This advancement facilitates the promotion of ultra-low dose scans in clinical scenarios, potentially detecting minimal and hidden lesions, thus significantly improving image quality. However, the current state of the art is limited and issues such as charge sharing, pulse pileup, K-escape and count rate drift remain unresolved. These issues could lead to a decrease in image resolution and energy resolution, while an increasing in image noise and ring artifact and so on. This article systematically reviewed the physical principles of PCD-CT, and outlined the structural differences between PCDs and energy integration detectors (EIDs), and the current challenges in the development of PCD-CT. In addition, the advantages and disadvantages of three detector materials were analysed. Then, the clinical benefits of PCD-CT were presented through the clinical application of PCD-CT in the three diseases with the highest mortality rate in China (cardiovascular disease, tumour and respiratory disease). The overall aim of the article is to comprehensively assist medical professionals in understanding the technological innovations and current technical limitations of PCD-CT, while highlighting the urgent problems that PCD-CT needs to address in the coming years.
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Tomography, X-Ray Computed/methods , Photons , Noise , China , Phantoms, ImagingABSTRACT
The “conception vessel， governor vessel and thorough vessel sharing the same origin” theory refers to the concept that the conception vessel， governor vessel and thorough vessel all originate from the same source within the uterus and emerge from the perineum. Based on the modern research of McNeal's prostate zonal anatomy theory， it is believed that the conception vessel， governor vessel and thorough vessel have the closest relationship with the prostate in terms of their origin and running course. It is proposed that the essential meaning of the ‘conception vessel， governor vessel and thorough vessel sharing the same origin’ theory in relation to the prostate is that the conception vessel， governor vessel and thorough vessel respectively connect to the transition zone， peripheral zone， and central zone of the prostate. Moreover， the differences in the yin-yang attributes of the conception vessel， governor vessel and thorough vessel exhibit distinct functional characteristics in different zones of the prostate， which serve as an important basis for the physiological and pathological differences in various prostate zones. Based on this premise， a prostate meridian， qi and blood syndrome differentiation method is further proposed， wherein the differences in the meridian characteristics of the conception vessel， governor vessel and thorough vessel determine the differences in the yin-yang aspects of qi and blood in different prostate zones. When clinical diagnosis is conducted， the inherent physiological differences of the different prostate zones should be fully taken into account， as well as the pathological characteristics of the disease， in order to guide the diagnosis and treatment of related clinical conditions.
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Asymptomatic spleen-stomach diseases refer to diseases without related symptoms and signs of abdo-minal pain， bloating， diarrhea an others in patients， but showing lesions or pathological changes discovered by modern medical techniques such as endoscopy， CT， MRI. The four examination techniques of traditional Chinese medicine （TCM） are based on symptoms and signs of patients， which are the advantage of TCM but also have certain limitations. In the context of the increasingly modernized diagnosis and treatment in TCM， it is proposed to expand the application of the four examination techniques from three aspects including microcosmic syndrome differentiation， data sharing， and artificial intelligence in asymptomatic spleen-stomach diseases， in order to achieve the goals of dynamically observing the disease process， collecting disease data in multiple dimensions， and intelligently processing disease data. This will strengthen the modern requirements of early diagnosis and treatment in TCM， and highlight the advantages of TCM in “treating disease before it arises and treating the symptoms beforehand”.
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Blockchain technology has the advantages of decentralization, secure sharing and tamper resistance, and high privacy, which can solve the current problem of sharing electronic medical records in medical institutions in China. A tertiary hospital established an electronic medical record sharing services convenience service platform based on blockchain in collaboration with China mobile gansu company in September 2021. The hardware architecture of the platform consisted of a hospital data warehouse, a local front-end computer and a blockchain platform. The functional architecture included platform front-end services, the blockchain electronic medical record archiving and service platform. The technical architecture included the underlying blockchain, service layer, interface layer and application layer, which was embedded with asymmetric encryption technology, hash algorithm, smart contract and other technical means, ensuring data ownership and on-demand, controllable, real-time and secure sharing of data. Since the operation of the platform in September 2021, as of October 2022, a tertiary hospital had accumulated 21 545 patient medical records on the chain. The overall operation of the platform was smooth, achieving reliable storage and secure sharing of patient electronic medical records, providing reference for further promoting the interconnection trusted sharing of electronic medical records in medical institutions in China.
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Objective:To explore the development, application and practical experience of investigator-initiated integrated clinical research information platform.Methods:The process of developing and constructing an integrated clinical research platform in a tertiary hospital in Beijing was introduced, the functions and advantages of the platform were described and displayed, and the main problems and risk points in the development and construction process were analyzed.Results:The integrated clinical research platform meets the management requirements of clinical research initiated by investigators, and the standardized management of the whole life cycle of the project can be realized through the platform, and the key issues of data security, information capture, sharing and interoperability need to be further explored in terms of platform docking.Conclusions:The integrated clinical research platform effectively improves the standardization, management quality and efficiency of investigator-initiated clinical research.
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Islet transplantation has developed rapidly over the last 20 years and is becoming one of the ideal clinical treatment options for type 1 diabetes mellitus (T1DM). There is growing clinical evidence that islet transplantation has significant efficacy in insulin independence or reduction, preventing hypoglycemic episodes and preventing diabetic complications.However, clinical islet transplantation still faces challenges, such as a shortage of donor resources, difficulties in early implantation and survival of islet grafts, and immune rejection.In the future, donor pancreatic donation and its effective utilization should be promoted, and clinical exploration of xenogeneic islet transplantation and stem cell-derived islet transplantation should be encouraged to effectively solve the problem of insufficient islet source.At the same time, through continuous research and development of new materials and technologies, optimize the location of islet transplantation to improve the implantation and survival of islet grafts, and gradually eliminate the need for immunosuppression.In addition, we should actively promote the development and application of post-islet transplantation graft monitoring tools to further ensure the long-term survival of post-islet transplantation grafts, so that more diabetic patients can benefit from it.
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The concept of "virus sovereignty" proposed by Indonesia in 2007 challenges the international tradition of virus sharing. In the context of the global outbreak of coronavirus disease 2019, the issue of virus sharing has become an important topic in the reform of the global health governance mechanisms. Virus sharing is an important guarantee of dealing with major global infectious diseases. However, the emergence of the concept of "virus sovereignty" shows that there are defects in the operation of virus sharing mechanism in the international community. The "virus sovereignty" problem is an ethical issue essentially, involving asymmetric interests hindering unity and cooperation, intellectual property rights expansion challenging the principle of solidarity, and excessive self-defense amplifying utility risks. "Community of common health for mankind" provides a constructive and feasible option to solve the dilemma of "virus sovereignty".
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Pancreatic diseases is a kind of complex, high-risk gastrointestinal diseases. Pancreatic cancer is highly malignant and seriously endangers people′s health. Developing multi-center, large-scale real world research can better understand the incidence patterns and treatment outcomes of pancreatic diseases. Based on the multi-center and heterogeneous data, the authors for-mulate data standards for real world studies of pancreatic diseases, and build a database of pancreatic cancer, integrating and sharing data from multi-center sources, in order to fully explore the scientific research value of pancreatic cancer clinical information, and provide experience and reference for the construction of other real world research specific disease databases in the future.
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Objective:To explore the effect of whole-process management mode based on "Internet + nursing service" in the management of children with concealed penis.Methods:This study adopted a quasi-experimental research method. A total of 383 children with concealed penis who were hospitalized in the Third Department of Urology of Hunan Provincial People′s Hospital from January 2018 to August 2021 were convenient selected. According to the sequence of admission, 195 children admitted from January 2018 to May 2020 were set as the control group, and 188 children admitted from June 2020 to August 2021 were set as the observation group. The control group was received conventional treatment and nursing, but the observation group was received whole-process management mode based on "Internet + nursing service". The length of hospitalization, incidence of complications after discharge, anxiety of the children′s parents and satisfaction of the doctors, the specialist & nurse sharing and the children′s parents were compared between the two groups.Results:Finally, 186 and 193 children were included in the observation group and the control group, respectively After the intervention, in the observation group, the length of hospitalization, anxiety score of the children′s parents, difference of anxiety score of the children′s parents, satisfaction content of the doctors, satisfaction effect of the doctors, satisfaction content of the specialist & nurse sharing, satisfaction effect of the specialist & nurse sharing, satisfaction content of the children′s parents and satisfaction effect of the children′s parents were (4.30 ± 1.35) d, (35.08 ± 3.17) points, (19.14 ± 4.35) points,(4.57 ± 0.54) points, (4.71 ± 0.49) points, (4.75 ± 0.50) points, (5.00 ± 0.00) points, (4.60 ± 0.49) points, (4.65 ± 0.49) points; in the control group, the scores were (5.50 ± 1.41) d, (44.79 ± 3.30) points, (9.22 ± 3.67) points, (3.71 ± 0.49) points, (4.00 ± 0.58) points, (3.50 ± 0.58) points, (3.25 ± 0.50) points, (3.54 ± 0.59) points, (3.64 ± 0.67) points. The differences between the two groups were statistically significant ( t values were -23.94-29.19, all P<0.05). The complication rates of the observation group and the control group were not statistically significant ( χ2=0.64, P>0.05). Conclusions:The whole-process management mode based on "Internet + nursing service" is beneficial to shorten the length of hospitalization, relieve the degree to anxiety of the children′s parents, improve the satisfaction of the doctors, the specialist & nurse sharing and the children′s parents, and accelerate the rehabilitation of children, which is worthy of clinical promotion.
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Abstract Introduction Increasingly, occupational therapists and scientists across the globe are calling for a shift away from individualised western medical approaches, to working with communities and collectives, and in the social field. This signals the growing motivation to engage in socially responsive and transformative practices that address political structures and oppressive colonial systems. Objective The purpose of our Community of Practice (CoP) was to explore and describe the epistemologies, vocabularies, and understandings that underpin community development and social occupational therapy within diverse global contexts to advance theoretical perspectives and practices. Method As a CoP of occupational therapy and science scholars situated in four countries (Australia, Brazil, Canada, and South Africa), we met virtually bi-monthly from March 2020 to January 2023. Scholarly work involved critical narrative literature reviews, reflexive presentations, group dialogues, and individual and collective reflections and analyses. Results Individual narratives, four thematic threads, and a selection of vocabularies and epistemologies are presented. The thematic threads were: Connecting and making space for decolonial praxis, Questioning the disconnect between occupational therapy practice and contexts, Examining vocabularies that shape contextually relevant practice, and Engaging a reflexive stance to work towards equity, justice and social rights. Conclusions Generating knowledge that supports ways of knowing, being and doing reflective of multiple languages, sciences, and contexts will strengthen occupational therapy. Maintaining the pluriversal and resisting 'one size fits all' approaches to human occupation/everyday life is essential. This paper offers practitioners a catalyst for initiating decolonising praxis for learning across global contexts.
Resumo Introdução De modo crescente, terapeutas ocupacionais mundialmente estão discutindo mudanças das abordagens médicas ocidentais individualizadas para o trabalho com comunidades, coletivos e no campo social. Isto sinaliza uma motivação crescente para se engajar em práticas socialmente responsivas e transformadoras que abordem estruturas políticas e sistemas coloniais opressores. Objetivo Explorar e descrever epistemologias, vocabulários e entendimentos que sustentam a teoria de desenvolvimento de comunidades e da terapia ocupacional social, em diversos contextos globais para avançar em perspectivas teóricas e práticas. Método A partir de uma Comunidade de Prática de terapeutas ocupacionais e acadêmicos situados em quatro países (Austrália, Brasil, Canadá e África do Sul), nos reunimos virtualmente bimestralmente de março de 2020 até janeiro de 2023. Nosso trabalho envolveu revisões narrativas críticas da literatura, apresentações reflexivas, diálogos em grupo e reflexões e análises individuais e coletivas. Resultados Foram escolhidos quatro fios temáticos e uma seleção de vocabulários e epistemologias: Conectando e abrindo espaço para a práxis decolonial, Questionando a desconexão entre a prática da terapia ocupacional e os contextos, Examinando vocabulários que moldam a prática contextualmente relevante e Engajando uma postura reflexiva para trabalhar em direção à equidade, justiça e direitos sociais. Conclusões A geração de conhecimento reflexivo que sustente formas de saber, ser e fazer requer múltiplas linguagens, ciências e contextos que fortalecem a terapia ocupacional. É essencial manter a pluriversalidade e resistir a abordagens únicas para trabalhar com a ocupação humana/vida cotidiana. Este artigo oferece um catalisador para iniciar uma práxis descolonizadora de aprendizado em contextos globais.
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RESUMO: Transcrição da conferência de Achille Mbembe, intitulada Pesar as vidas, proferida em 5 de novembro de 2020 na XIX Jornada do Espaço Brasileiro de Estudos Psicanalíticos do Rio de Janeiro. Neste ensaio o pensador camaronês desenvolve suas teses apresentadas em Políticas da inimizade e Brutalismo sobre as políticas do vivente que o tempo presente exige, sobretudo quanto ao direito à respiração e ao pertencimento da Terra relativamente a todos os viventes, humanos e não humanos. Em que medida o projeto psicanalítico, nos seus termos, contribui para a pluralização dos saberes e a refundação deles pela retomada dos arquivos do Todo-Mundo, é uma de suas interrogações à psicanálise. Finalmente, é em torno do incalculável presente em todo vivente que Achille Mbembe defende a ideia de que o vivente é aquilo que não tem preço, nem se pode pesar.
ABSTRACT: Transcript of Achille Mbembe's conference, entitled Weighing Lives, given on November 5, 2020, at the XIX Journey of the Brazilian Space for Psychoanalytic Studies in Rio de Janeiro. In this essay, the Cameroonian thinker develops his theses presented in Policies of Enmity and Brutalism about the policies of the living that the present time requires, especially regarding the right to breathe and the belonging of the Earth to all living things, human and non-human. To what extent the psychoanalytic project, in its terms, contributes to the pluralization of knowledge and its refoundation through the resumption of the All-World archives is one of its questions for psychoanalysis. Finally, it is around the incalculable present in every living thing that Achille Mbembe defends the idea that the living thing is that which has no price and cannot be weighed.
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Politics , Violence , Ethnic ViolenceABSTRACT
La producción peruana de cacao representa aproximadamente el 2% de la producción mundial; con una contribución muy reconocida por la calidad y diversidad de sus sabores y aromas. De milenario origen amazónico y probada utilización de hace por lo menos 5200 años, este cultivo recién ha sido visible para el desarrollo agrario en las dos últimas décadas, cuando se le ha utilizado con relativo éxito en la sustitución de cultivos ilegales de coca ¿Y qué tanto está contribuyendo la academia a la cadena de valor del cacao? Con carácter exploratorio, se registró y analizó una muestra de 44 tesis que tenían como objeto de estudio el cacao, obtenido por sus autores en los centros de producción y parcelas de productores. La mayor parte de estas tesis (41) estuvieron destinadas a obtener títulos profesionales, dos para optar el grado de magister y uno para obtener el grado de doctorado. Estas tesis se realizaron en universidades de 13 departamentos del Perú, contando Lima con el mayor número de tesis (12). Once tesis abarcaron actividades de investigación del germoplasma para la transformación y/o la innovación del cacao, confiriéndole así valor agregado con potencial uso comercial. Estas investigaciones estuvieron relacionadas con cuatro sectores productivos con un claro potencial comercial en el mercado global de recursos genéticos. En ningún caso, las investigaciones se realizaron bajo la seguridad jurídica del sistema de acceso a recursos genéticos y participación justa y equitativa de beneficios del Protocolo de Nagoya, del Convenio sobre la Diversidad Biológica.
The Peruvian production of cocoa represents, approximately, 2% of the world production, with a very recognized contribution because of the quality and diversity of its flavors and aromas. With a millenary Amazonian origin and proved utilization by at least 5200 years ago, this crop just became visible for the agrarian development in the last two decades, when it was used with relative success for the substitution of illegal coca crops. And how much is the academy contributing to the value chain of cocoa? A sample of 44 theses which cocoa obtained from production centers and farmers plots was their object of study, has been registered and analyzed in an exploratory way. 41 theses were to get professional titles, two for magister degree and one for doctorate degree. These theses were done in universities of 13 Department of Peru, where Lima reached the highest number (12). Eleven theses addressed germplasm research activities aimed to cocoa transformation and/or innovation, thus conferring added value with potential commercial use. These researches were related to four productive sectors with a clear potential in the global market of genetic resources. In any case, the studies were done under the legal certainty of the system of access to genetic resources and fair and equitable benefit-sharing of the Nagoya Protocol to the Convention on Biological Diversity.
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Risk Sharing Agreement is defined as an agreement in which the State agrees to offer temporary access to a new drug, while the pharmaceutical industry accepts to receive the product according to the performance of the drug in real conditions of use. Risk sharing necessarily depends on the collection of additional evidence that may refer to the therapeutic benefits or the volume of patients, according to the assessment of its use in practice. The authors described the experience of the pilot project of a Risk Sharing Agreement in the Unified Health System.
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O Acordo de Compartilhamento de Risco é definido como um acordo no qual o Estado concorda em oferecer acesso temporário a um novo medicamento, enquanto a indústria farmacêutica aceita receber pelo produto conforme o desempenho do medicamento em reais condições de uso. A partilha de risco depende, necessariamente, da coleta de evidências adicionais, que podem se referir aos benefícios terapêuticos ou ao volume de pacientes, conforme avaliação de seu uso na prática. Os autores descreveram a experiência do projeto-piloto de Acordo de Compartilhamento de Risco no Sistema Único de Saúde.
Risk Sharing Agreement is defined as an agreement in which the State agrees to offer temporary access to a new drug, while the pharmaceutical industry accepts to receive the product according to the performance of the drug in real conditions of use. Risk sharing necessarily depends on the collection of additional evidence that may refer to the therapeutic benefits or the volume of patients, according to the assessment of its use in practice. The authors described the experience of the pilot project of a Risk Sharing Agreement in the Unified Health System.
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Technology Assessment, Biomedical , Unified Health System , Risk Sharing, FinancialABSTRACT
Objective:In order to allow the large instruments to play the greatest role in scientific research management and technology coverage.Methods:Texts review of the opening and sharing of large-scale instrument platforms of domestic and foreign universities and scientific research institutions was conducted, combined with the experience of more than 10-year operation of the technology platform of State Key Laboratory of Natural and Biomimetic Drugs of Peking University.Results:There are particular problems in the opening and sharing of large-scale instrument technology service platforms at this stage. Through building the hierarchical management of large instruments and equipment, building an efficient and flexible shared management information system, introducing high-level instrument management and high-level talents, and strengthening the security management of the shared platform, State Key Laboratory of Natural and Biomimetic Drugs of Peking University realized the opening and sharing of large-scale instrument technology service platforms. We consider that the current large-scale instrument technology service platforms of universities and research institutes are necessary and feasible to be shared. It is greatly significant to improve the utilization rate of scientific research instruments and to innovate to the ability of the whole society.Conclusions:At this stage, efficient management, system capabilities, and team building can effectively promote the opening and sharing of large-scale instrument technology service platforms.
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The preliminary trial began with the exchange of reports between pharmacy pharmacists and nurses from home-visit nursing stations in Tempaku-ku, Nagoya-city, and then the collection of survey results to investigate the transition of mutual credibility, opinions on maintaining alignments, and the effect of collaboration. It was established that there were distinct viewpoints based on professions, even when the cases belonged to the same category in the sharing reports. For instance, in terms of pharmacotherapy, the reports by pharmacists were focused on suggesting pharmaceutical management such as left-over medicines or prescriptions, whereas the reports by nurses were targeted on how to finish up all prescribed medicines and described more vital signs, treatments, and cognitive ability in the category of symptom. In the survey results, 86.7% of the respondents answered that sharing information between pharmacists and nurses should strengthen the synergistic effect. It was suggested that the working relationship between pharmacists and nurses would develop by sharing information with each other. And, ultimately, each pharmacist’s and nurse’s viewpoint will be expected to play a significant role in providing a stronger support for an ideal life according to the patient’s will, fostering a very intense relationship across different professions alongside all assessments and proposals based on expertise, and improving the quality of each work.
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With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.
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The outpatient and emergency electronic medical record system is an important part of the hospital information system. By analyzing the current outpatient and emergency electronic medical record system in hospitals in China, this paper rounded up weaknesses in the development of the outpatient and emergency electronic medical record system in terms of management standards, support, technology bottleneck, data sharing and security. On such basis, the authors suggested to improve the policy standards, clarify the construction objectives, increase the support, optimize the system functions and strengthen the security management, which aimed at promoting the high-quality development of the construction of outpatient and emergency electronic medical record system in China′s hospitals.
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Medical alliances constitute a vertical integration of regional medical resources, and an effective means to promote the tiered medical services. As one of the largest tertiary hospitals in Xinjiang, a hospital has gradually built a " 1+ 6+ N" medical alliance cooperative system fitting the geographical characteristics of Xinjiang since 2018. The system was based on the hospital, made county-level medical institutions as the hub, primary medical and health units as the focus, and telemedicine as the bridge. It turned a telemedicine service platform as the medium, integrating such service segments, as offline practices of experts like clinical teaching, ward rounds, surgical guidance and discipline construction, and as online practices like remote consultation, remote diagnosis, remote education, and remote new technology training among others. Then these segments were integrated into such cooperative models as the remote cooperative medical alliances, specialist-cooperative medical alliances, inter-department co-construction medical alliances, precision-based assistance medical alliances, urban medical group type of medical alliances, and " alliance-consortium" integrated development medical alliances. These practices enabled the expansion and primary support of high-quality medical resources. By June 2022, the hospital had established cooperation via medical alliances with 285 medical institutions at all levels. The implementation of this cooperation mechanism has effectively improved the medical service capacity, diagnosis and treatment capacity of difficult and critical diseases, diagnosis and treatment homogeneity and remote diagnosis capacity in the region, as well as the smooth and orderly progress of the tiered medical services and two-way referrals within a medical alliance.
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In order to effectively integrate scientific research data resources and improve data utilization, the National Clinical Medical Research Center had built a "3321" -integration big data sharing innovation platform. By providing full support to scientific research, sorting out the distribution mechanism of achievements, and formulating authority management norms, the big data platform had solved the weaknesses in data sharing ability, sharing willingness, and sharing security, giving full play to the effectiveness of the clinical research big data platform. By February 2022, the center had collected more than 1.04 million elderly patients data through the big data platform, as well as carried out 75 scientific research projects, and established 10 large population-based clinical research queues. The big data platform had realized full coverage of major diseases in the field of geriatric diseases, promoted the high-quality construction of the national clinical medical research center, and improved the scientific research and innovation ability of the cooperative units.