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Heterogeneous length-of-stay modeling of post-acute care residents in the nursing home with competing discharge dispositions

《工程管理前沿（英文）》   页码 577-591 doi: 10.1007/s42524-022-0203-7

摘要： Post-acute care (PAC) residents in nursing homes (NHs) are recently hospitalized patients with medically complex diagnoses, ranging from severe orthopedic injuries to cardiovascular diseases. A major role of NHs is to maximize restoration of PAC residents during their NH stays with desirable discharge outcomes, such as higher community discharge likelihood and lower re/hospitalization risk. Accurate prediction of the PAC residents’ length-of-stay (LOS) with multiple discharge dispositions (e.g., community discharge and re/hospitalization) will allow NH management groups to stratify NH residents based on their individualized risk in realizing personalized and resident-centered NH care delivery. Due to the highly heterogeneous health conditions of PAC residents and their multiple types of correlated discharge dispositions, developing an accurate prediction model becomes challenging. Existing predictive analytics methods, such as distribution-/regression-based methods and machine learning methods, either fail to incorporate varied individual characteristics comprehensively or ignore multiple discharge dispositions. In this work, a data-driven predictive analytics approach is considered to jointly predict the individualized re/hospitalization risk and community discharge likelihood over time in the presence of varied residents’ characteristics. A sampling algorithm is further developed to generate accurate predictive samples for a heterogeneous population of PAC residents in an NH and facilitate facility-level performance evaluation. A real case study using large-scale NH data is provided to demonstrate the superior prediction performance of the proposed work at individual and facility levels through comprehensive comparison with a large number of existing prediction methods as benchmarks. The developed analytics tools will allow NH management groups to identify the most at-risk residents by providing them with more proactive and focused care to improve resident outcomes.

关键词： nursing home     predictive analytics     individualized prediction     competing risks     health outcomes    

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Linking elements to outcomes of knowledge transfer in the project environment: Current review and future

《工程管理前沿（英文）》 2022年 第9卷 第2期   页码 221-238 doi: 10.1007/s42524-022-0195-3

摘要： A project is a specific effort to create a unique product, so it is a favorable place for knowledge creation and development. Knowledge can be transferred inside and outside projects and their parent project-based organizations, thus affecting project performance and organizational competitiveness. However, the current research on the elements and outcomes of knowledge transfer (KT) in the project environment lacks completeness and clarity, and that on the different levels of KT is fragmented. This study aims to conduct comprehensive research to determine and link the elements and outcomes of KT in the project environment. The authors systematically analyzed the relevant literature from 2000 to 2021, which showed an increasing publication trend. They divided KT in the project environment into three levels according to the transfer scenario: Intra-project, cross-project, and cross-organizational KT. Five-dimensional transfer elements and two-dimensional transfer outcomes were then identified and analyzed from previous literature. Lastly, the relationships between the transfer elements and outcomes were gathered to create a comprehensive model. Importantly, the knowledge gap in the current literature was highlighted, and future research directions were put forward. This study builds a theoretical framework linking transfer elements to outcomes that can serve as a basis for scholars and practitioners to develop effective strategies for KT in the project environment.

关键词： knowledge transfer     knowledge management     project management     project environment     literature review    

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Clinical characteristics and outcomes of biopsy-proven diabetic nephropathy

null

《医学前沿（英文）》 2017年 第11卷 第3期   页码 386-392 doi: 10.1007/s11684-017-0574-z

摘要：

Kidney damage is common in patients with diabetes mellitus (DM). However, whether the type of kidney damage can be reliably diagnosed using clinical data alone remains unclear. Predictive factors for diabetic nephropathy (DN) outcomes are also poorly understood. In this study, the clinical manifestations of 111 cases of biopsy-proven DN were described, and the clinical and pathological parameters of patients with different DN outcomes were compared. Results showed that long DM duration (>10 years in 32.4% of patients), severe proteinuria (62.2%), and renal dysfunction (estimated glomerular filtration rate [eGFR]<60 mL/(min·1.73 m2)) (52.3%) did not accurately indicate whether the condition of these patients progressed to DN. Hematuria (48.6%) failed to specify either DN or nondiabetic renal disease. Diabetic retinopathy (78.4%) was a crucial complication in patients with DN. Kaplan–Meier analysis revealed that the renal survival of 53 patients who were diagnosed with DN and were followed up was not significantly associated with glomerular classification (P>0.05). Cox’s regression analysis demonstrated that renal survival time was significantly influenced by sex (b= 1.394, P= 0.038), hematuria (b= 0.036, P= 0.029), and eGFR (b= −0.039, P= 0.002) but was not significantly affected by age, 24 h urinary protein excretion, or glomerular classification (P>0.05). In conclusion, the clinical characteristics of DN vary, and renal biopsy is necessary to determine renal damage patterns. Sex, hematuria, and the eGFR may affect DN outcomes, whereas the glomerular classification may not.

关键词： diabetic nephropathy     clinical characteristics     renal biopsy     outcomes    

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新冠病毒肺炎疫苗分配 ——模拟可替代策略的健康结局和公正性影响 Article

Maddalena Ferranna, Daniel Cadarette, David E. Bloom

《工程（英文）》 2021年 第7卷 第7期   页码 924-935 doi: 10.1016/j.eng.2021.03.014

摘要：

鉴于缺乏安全有效的新冠病毒肺炎（COVID-19）疫苗，一个主要的政策问题是如何在不同的社会人口学特征群体中分配疫苗。本文评估了迄今为止提出的COVID-19疫苗优先策略，重点关注其既定目标；所选分配方案对于大流行病进程和负担的影响机制；以及制定优先策略时出现的流行病学、经济、后勤和政治等主要问题。本文将一个简洁、按年龄分层的易感-暴露-感染-恢复模型应用于美国，以定量评估替代优先策略在保护死亡、保护感染和延长寿命方面的表现。我们证明了优先考虑重点岗位人群是减少病例数量和降低死亡损失生命年的可行策略，而在大多数情况下，通过优先考虑老年人来实现死亡人数的最大减少，即使疫苗能有效阻止病毒传播。这一特性的不确定性和疫苗针剂支付的潜在延迟加强了优先考虑老年人的呼吁。此外，我们还调查了支持分配策略的公平动机的强度，该策略将绝对优先考虑给予重点岗位人群能降低感染致死风险的疫苗。

关键词： 疫苗分配     COVID-19     公正性     SEIR模型    

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Clinical manifestations and outcomes in severe ulcerative colitis

YANG Xuesong, YAO Wei, LIU Wenbin, LI Jun, LU Yumin

《医学前沿（英文）》 2007年 第1卷 第2期   页码 192-195 doi: 10.1007/s11684-007-0036-0

摘要： In order to evaluate the clinical manifestations and outcomes of severe ulcerative colitis (UC), we retrospectively reviewed 41 patients with severe UC from 144 consecutively hospitalized UC cases from 1988 to 2004. Data recorded included onset, symptoms, signs, laboratory results, endoscopic, radiologic and pathologic findings, the clinical treatment process and follow-up. Of these severe cases, 92.7% (38/41) had pancolitis. Clinically, 36.9% (15/41) were categorized as first onset type, 36.9% (15/41) were chronic persistent and 26.8% (11/41) were chronic recurrent. Steroids played a main role in the remission of severe UC (61.0%). Thirty-one cases (75.6%) were relieved by drug therapy. Seven cases (17.1%) progressed to the need for operation. An early age of onset, pancolitis, low hemoglobin and serum albumin levels, and the need for intravenous steroids tended to be associated with the need for surgery. In conclusion, most of the severe UC patients respond well to drug therapy, but for individuals who are unresponsive to drug therapy, or for those depending on steroids, after a reasonable duration of treatment, the necessity for surgery should be considered.
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Clinical outcomes of ATP-tumor chemosensitivity assay directed chemotherapy in hepatocellular carcinoma

RAO Rongsheng, CHEN Wenxue, ZHOU Xinwen, ZHOU Zheng, LI Xiaojun, ZENG Zhiping

《医学前沿（英文）》 2007年 第1卷 第2期   页码 157-160 doi: 10.1007/s11684-007-0029-z

摘要： This study aims to investigate the clinical response of ATP tumor chemosensitivity assay (ATP-TCA) directed chemotherapy regimens delivered via hepatic artery infusion in 104 cases of primary liver carcinoma (PLC). Tumor tissue was obtained via laparotomy and cultivated in vitro. This tissue was put through the assay to determine chemosensitivity. A single drug regimen of either 5-FU, MMC and ADM and a combination drug regimen were used. The treatment assigned was dependent on the result of the ATP-TCA. In the control group, 30 cases of diagnosed PLC were given the conventional three-combination drug. The two groups were evaluated after three courses of chemotherapy. The results are as follows. The overall response rate of sensitivity test ranged from 36% to 44% in the single drug therapy groups and 81% in the combination drug group. The clinical overall response rate was 75% in the treatment group and 56% in control group. The treatment group had better results than the control group as survival period over six months was 80% and over one year 44%. In the control group, survival period over six months was 60% and 30% over one year. In short, ATP-TCA directed chemotherapy shows better results for terminal stages of PLC in that you can decrease the dose of drugs thereby reducing the side-effects with possible improvements in therapeutic effects.
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Analysis of the treatment outcomes of esophageal variceal bleeding patients from multiple centers in

WANG Zhiqiang

《医学前沿（英文）》 2008年 第2卷 第2期   页码 171-173 doi: 10.1007/s11684-008-0031-0

摘要： This study aimed to investigate the treatment outcomes of esophageal variceal bleeding (EVB) in China. A total of 1087 cases were collected from 19 hospitals in 16 large and medium sized cities across China between January 1st, 2005 and January 1st, 2006. There were 313 cases (29.0%) of mild (<400 mL), 494 cases (45.8%) of moderate (400–1500 mL) and 272 cases (25.2%) of severe (>1500 mL) bleeding. Successful hemostasis was achieved in 89.8% of cases. Seven hundred and eighty-five cases were treated by medication with a hemostasis rate of 91.8%. Seventy-one cases were treated using a Sengstaken-Blakemore tube with a hemostasis rate of 54.9%. Thirty-seven cases were treated with emergency endoscopic variceal ligation with a hemostasis rate of 83.8%. Seventy-seven cases were treated with endoscopic sclerotherapy with a hemostasis rate of 94.8%. Forty-three cases were treated with emergency surgical operation with a hemostasis rate of 95.3%. Sixty-six cases were treated with combined therapy with a hemostasis rate of 97.0%. There was a significant difference ( < 0.01) in the successful hemostasis rate between different treatments. The overall mortality was 10.1%, among which 6.6% was directly caused by bleeding. The multivariate logistic regression analysis shows that the severity of bleeding, treatment methods, liver dysfunction and activation of hepatitis were predictive factors for successful hemostasis. Most cases of EVB were mild and moderate in severity. The first-line treatment for EVB is medication. Emergency endoscopic intervention has not been widely available yet. The overall management outcome of EVB has been improved.

关键词： significant difference     predictive     medication     first-line treatment     bleeding    

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mTOR-targeted cancer therapy: great target but disappointing clinical outcomes, why?

Shi-Yong Sun

《医学前沿（英文）》 2021年 第15卷 第2期   页码 221-231 doi: 10.1007/s11684-020-0812-7

摘要： The mammalian target of rapamycin (mTOR) critically regulates several essential biological functions, such as cell growth, metabolism, survival, and immune response by forming two important complexes, namely, mTOR complex 1 (mTORC1) and complex 2 (mTORC2). mTOR signaling is often dysregulated in cancers and has been considered an attractive cancer therapeutic target. Great efforts have been made to develop efficacious mTOR inhibitors, particularly mTOR kinase inhibitors, which suppress mTORC1 and mTORC2; however, major success has not been achieved. With the strong scientific rationale, the intriguing question is why cancers are insensitive or not responsive to mTOR-targeted cancer therapy in clinics. Beyond early findings on induced activation of PI3K/Akt, MEK/ERK, and Mnk/eIF4E survival signaling pathways that compromise the efficacy of rapalog-based cancer therapy, recent findings on the essential role of GSK3 in mediating cancer cell response to mTOR inhibitors and mTORC1 inhibition-induced upregulation of PD-L1 in cancer cells may provide some explanations. These new findings may also offer us the opportunity to rationally utilize mTOR inhibitors in cancer therapy. Further elucidation of the biology of complicated mTOR networks may bring us the hope to develop effective therapeutic strategies with mTOR inhibitors against cancer.

关键词： mTOR     cancer therapy     resistance     GSK3     protein degradation     E3 ubiquitin ligase     PD-L1    

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免费孕前优生健康检查对象潜在危险因素接触和妊娠结局分析

车焱,周公望,王彩琴,张焕玲,张建娥,闫立新,陆珍,陆梅,沈洁,朱昊平

《中国工程科学》 2014年 第16卷 第5期   页码 56-59

摘要：

分析并报告上海市静安区免费孕前优生健康检查后待孕夫妇不良妊娠结局潜在影响因素接触情况以及妊娠率和妊娠结局，为免费孕前健康检查政府实施项目效果的评估提供基础数据。对2011 年8 月—2012 年11 月在静安区参加免费孕前优生健康检查的所有对象在其检查结束后的3 个月、6 个月、12 个月进行随访，重点关注不良妊娠结局潜在危险因素接触情况以及妊娠时间和妊娠结局。统计方法为χ2检验、寿命表、Logistic 回归分析。在目标时段内共有1 480 对夫妇参加了免费孕前优生健康检查，其中1 249 对服务对象接受了随访，随访率为84.4 %。截至2013 年4 月，48.7 %的随访对象已经受孕，孕前检查后3 个月调查累积妊娠率为23.9 %，6 个月调查累积妊娠率为45.0 %。365 人完成妊娠结局的随访，结果显示，早产率为3.0 %，低出生体重率为4.3 %，巨大儿发生率为3.3 %。自然流产率为6.3 %。另外，发现出生缺陷1 人，占妊娠妇女数的0.16 %，占有妊娠结局妇女数的0.27 %。烟酒等不良生活习惯丈夫的比例（18 %～20 %）高于妻子（1 %～3 %），77 %的丈夫和妻子接受潜在电磁辐射的时间超过8 h。9 %的夫妇自述生活和工作中接触重金属以及农药、化肥等潜在致畸物。超过10 %的妻子在怀孕以后接触了潜在致畸物。初步分析未发现上述因素与不良妊娠结局的关系。静安区孕前健康检查后半年内妇女妊娠率不到50 %，有必要在上海乃至全国开展免费孕前健康检查的成本效益评估。

关键词： 孕前优生健康检查     妊娠率     累积妊娠率     不良妊娠结局     危险因素    

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Clinical outcomes and prognostic factors of patients with epithelial ovarian cancer subjected to first-line

null

《医学前沿（英文）》 2014年 第8卷 第1期   页码 91-95 doi: 10.1007/s11684-014-0305-7

摘要：

A total of 251 patients with epithelial ovarian cancer (EOC) treated between 2002 and 2008 was retrospectively analyzed to investigate the long-term outcomes and prognostic factors of these patients, particularly those who underwent primary debulking surgery followed by platinum-based chemotherapy. Clinico-pathological parameters, including progression-free survival (PFS) and overall survival (OS), were also analyzed. The median follow-up period from the end of initial treatment to June 2010 was 58 months. The three-year PFS rate was 61.7% for International Federation of Gynecology and Obstetrics (FIGO) I–II, 19.9% for FIGO III–IV, and 33.9% for all stages. By comparison, the five-year PFS rate was 44.6% for FIGO I–II, 17.7% for FIGO III–IV, and 28.3% for all stages. The three-year OS rate was 67.9% for FIGO I–II, 41.7% for FIGO III–IV, and 50.2% for all stages. The five-year OS rate was 52.7% for FIGO I–II, 30.8% for FIGO III–IV, and 39.2% for all stages. Univariate analysis revealed that advanced FIGO stage, serum CA125, and suboptimal debulking were significant factors affecting PFS and OS. In multivariate analysis, PFS was significantly influenced by FIGO stage and suboptimal debulking. However, OS was significantly influenced by advanced FIGO stage only. Our study confirms the efficacy of surgery followed by platinum-based chemotherapy for EOC. FIGO stage is considered as one of the most reliable predictors of the prognosis of patients with EOC.

关键词： ovarian carcinoma     prognostic factors     surgery     chemotherapy     survival    

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Overexpression of netrin-1 improves neurological outcomes in mice following transient middle cerebral

null

《医学前沿（英文）》 2011年 第5卷 第1期   页码 86-93 doi: 10.1007/s11684-011-0118-x

摘要：

Netrin-1 (NT-1) is one of the axon-guiding molecules that are critical for neuronal development. Because of its structural homology to the endothelial mitogens, NT-1 may have similar effects on vascular network formation. NT-1 was shown to be able to stimulate the proliferation and migration of human cerebral endothelial cells in vitro and also promote focal neovascularization in adult brain in vivo. In the present study, we reported the delivery of NT-1 using an adeno-associated virus (AAV) vector (AAV-NT-1) into mouse brain followed by transient middle cerebral artery occlusion (tMCAO). We found that AAV vectors did not elicit a detectable inflammatory response, cell loss or neuronal damage after brain transduction. The level of NT-1 was increased in the AAV-NT-1-transduced tMCAO mice compared with the control mice. Furthermore, the neurobehavioral outcomes were significantly improved in AAV-NT-1-transduced mice compared with the control animals (P<0.05) 7 days after tMCAO. Our data suggests that NT-1 plays a neuronal function recovery role in ischemic brain and that NT-1 gene transfer might present a valuable approach to treat brain ischemic disorders.

关键词： adeno-associated virus     angiogenesis     gene transfer     ischemia     middle cerebral artery occlusion     netrin-1    

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Effect of antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis

Jing Yue, Bo Zhang, Mingyue Wang, Junning Yao, Yifan Zhou, Ding Ma, Lei Jin

《医学前沿（英文）》 2019年 第13卷 第1期   页码 121-125 doi: 10.1007/s11684-018-0615-2

摘要： This retrospective study aims to demonstrate the effect of antitubercular treatment (ATT) on the pregnancy outcomes and prognoses of patients with genital tuberculosis (GTB) who had received laparoscopy and/or hysteroscopy. This study included 78 patients with infertility and who were diagnosed with GTB through laparoscopy and/or hysteroscopy over the period of November 2005 to October 2015. The recruited patients were divided into ATT and nonATT groups on the basis of ATT duration. The GTB recurrence rates, menstrual patterns, and pregnancy outcomes of the patients were determined at follow-up. Among the 78 patients, 46 received ATT and 32 did not receive ATT. The menstrual volumes of patients in the ATT group significantly decreased relative to those of patients in the nonATT group. GTB did not recur among all patients regardless of treatment. A total of 11 pregnancies (36.7%) in the ATT group and 19 pregnancies (63.3%) in the nonATT group were observed. Pregnancy rates significantly differed ( = 0.002) between the two groups. ATT may decrease the menstrual volume and pregnancy rates of patients who were diagnosed with GTB through laparoscopy and/or hysteroscopy. In addition, ATT did not improve the prognosis of patients with chronic GTB.

关键词： antitubercular treatment     pregnancy     prognosis     genital tuberculosis    

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Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis

null

《医学前沿（英文）》 2013年 第7卷 第3期   页码 354-366 doi: 10.1007/s11684-013-0257-3

摘要：

Due to the implementation of directly observed treatment strategy (DOTS), China has made a significant achievement in tackling the tuberculosis (TB) epidemic in the 1990s. However, only half of regions in China met or exceeded the 85% rate of treatment success target. The aim of the present study is to summarize the treatment outcomes of smear-positive pulmonary TB in the mainland of China in the past decade using meta-analysis based on systematic review of published observational studies. A total of 50 eligible articles (58 studies) were identified and included in this study. The summarized treatment success rates were 93.9% (95% CI, 92.8%–94.7%) for new cases and 85.4% (95% CI, 83.0%–87.6%) for previously treated cases, and the summarized cured rate were 92.2% (95% CI, 90.9%–93.3%) and 81.2% (95% CI, 79.1%–83.1%), respectively. A remarkable increase of rates for treatment success and cure was observed in the 1990s. After 2000, the summarized treatment outcomes were tending towards stability. In addition, geographic areas, type of the data and administrative level of the hospital were also found to influence the estimates of the treatment outcomes. Results of the present study clearly show, in general, that the pulmonary TB treatment achieved significant success in the past decade in the mainland of China. However, it needs to be further strengthened in the central and west areas.

关键词： tuberculosis     treatment     outcome     China     meta-analysis    

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Primary health care for all by 2020: The systematic reform of the medical and health system in China

《医学前沿（英文）》 2010年 第4卷 第1期   页码 3-7 doi: 10.1007/s11684-010-0024-7

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Outcomes of haploidentical bone marrow transplantation in patients with severe aplastic anemia-II that

《医学前沿（英文）》 2021年 第15卷 第5期   页码 718-727 doi: 10.1007/s11684-020-0807-4

摘要： Severe aplastic anemia II (SAA-II) progresses from non-severe aplastic anemia (NSAA). The unavailability of efficacious treatment has prompted the need for haploidentical bone marrow transplantation (haplo-BMT) in patients lacking a human leukocyte antigen (HLA)-matched donor. This study aimed to investigate the efficacy of haplo-BMT for patients with SAA-II. Twenty-two patients were included and followed up, and FLU/BU/CY/ATG was used as conditioning regimen. Among these patients, 21 were successfully engrafted, 19 of whom survived after haplo-BMT. Four patients experienced grade II–IV aGvHD, including two with grade III–IV aGvHD. Six patients experienced chronic GvHD, among whom four were mild and two were moderate. Twelve patients experienced infections during BMT. One was diagnosed with post-transplant lymphoproliferative disorder and one with probable EBV disease, and both recovered after rituximab infusion. Haplo-BMT achieved 3-year overall survival and disease-free survival rate of 86.4%±0.73% after a median follow-up of 42 months, indicating its effectiveness as a salvage therapy. These promising outcomes may support haplo-BMT as an alternative treatment strategy for patients with SAA-II lacking HLA-matched donors.

关键词： severe aplastic anemia     non-severe acquired aplastic anemia     haploidentical bone marrow transplantation     outcomes    

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标题 作者 时间 类型 操作

Heterogeneous length-of-stay modeling of post-acute care residents in the nursing home with competing discharge dispositions

期刊论文

Linking elements to outcomes of knowledge transfer in the project environment: Current review and future

期刊论文

Clinical characteristics and outcomes of biopsy-proven diabetic nephropathy

null

期刊论文

新冠病毒肺炎疫苗分配 ——模拟可替代策略的健康结局和公正性影响

Maddalena Ferranna, Daniel Cadarette, David E. Bloom

期刊论文

Clinical manifestations and outcomes in severe ulcerative colitis

YANG Xuesong, YAO Wei, LIU Wenbin, LI Jun, LU Yumin

期刊论文

Clinical outcomes of ATP-tumor chemosensitivity assay directed chemotherapy in hepatocellular carcinoma

RAO Rongsheng, CHEN Wenxue, ZHOU Xinwen, ZHOU Zheng, LI Xiaojun, ZENG Zhiping

期刊论文

Analysis of the treatment outcomes of esophageal variceal bleeding patients from multiple centers in

WANG Zhiqiang

期刊论文

mTOR-targeted cancer therapy: great target but disappointing clinical outcomes, why?

Shi-Yong Sun

期刊论文

免费孕前优生健康检查对象潜在危险因素接触和妊娠结局分析

车焱,周公望,王彩琴,张焕玲,张建娥,闫立新,陆珍,陆梅,沈洁,朱昊平

期刊论文

Clinical outcomes and prognostic factors of patients with epithelial ovarian cancer subjected to first-line

null

期刊论文

Overexpression of netrin-1 improves neurological outcomes in mice following transient middle cerebral

null

期刊论文

Effect of antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis

Jing Yue, Bo Zhang, Mingyue Wang, Junning Yao, Yifan Zhou, Ding Ma, Lei Jin

期刊论文

Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis

null

期刊论文

Primary health care for all by 2020: The systematic reform of the medical and health system in China

期刊论文

Outcomes of haploidentical bone marrow transplantation in patients with severe aplastic anemia-II that

期刊论文