搜索结果：American journal of translational research

Medical education research contributes to translational science (TS) when its outcomes not only impact educational settings, but also downstream results, including better patient-care practices and improved patient outcomes. Simulation-based medical education (SBME) has demonstrated its role in achieving such distal results. Effective TS also encompasses implementation science, the science of health-care delivery. Educational, clinical, quality, and safety goals can only be achieved by thematic, sustained, and cumulative research programs, not isolated studies. Components of an SBME TS research program include motivated learners, curriculum grounded in evidence-based learning theory, educational resources, evaluation of downstream results, a productive research team, rigorous research methods, research resources, and health-care system acceptance and implementation. National research priorities are served from translational educational research. National funding priorities should endorse the contribution and value of translational education research. Medical education research contributes to translational science (TS) when its outcomes not only impact educational settings, but also downstream results, including better patient-care practices and improved patient outcomes. Simulation-based medical education (SBME) has demonstrated its role in achieving such distal results. Effective TS also encompasses implementation science, the science of health-care delivery. Educational, clinical, quality, and safety goals can only be achieved by thematic, sustained, and cumulative research programs, not isolated studies. Components of an SBME TS research program include motivated learners, curriculum grounded in evidence-based learning theory, educational resources, evaluation of downstream results, a productive research team, rigorous research methods, research resources, and health-care system acceptance and implementation. National research priorities are served from translational educational research. National funding priorities should endorse the contribution and value of translational education research. Agency for Healthcare Research and Quality complex service intervention implementation science medical ICU National Institutes of Health simulation-based medical education translational science Translational science (TS) has been defined historically within the biomedical disciplines. The traditional TS definition involves research that progresses from bench to bedside in three phases. T1 science involves basic laboratory discoveries in the biomedical sciences. T2 science aims to produce evidence of T1 effectiveness at the individual patient level, compare the success of different treatments to identify “the right treatment for the right patient in the right way at the right time,” and translate these results into practice guidelines for patients, clinicians, and policy makers.1Dougherty D Conway PH The “3T's” road map to transform US health care: the “how” of high-quality care.JAMA. 2008; 299: 2319-2321Crossref PubMed Scopus (279) Google Scholar T3 science addresses health-care delivery, community engagement, and preventive services that produce measureable improvements in the health of individuals and society.1Dougherty D Conway PH The “3T's” road map to transform US health care: the “how” of high-quality care.JAMA. 2008; 299: 2319-2321Crossref PubMed Scopus (279) Google ScholarThe biomedical TS imperative has been expressed for at least a century. In his 1905 Nobel Prize lecture titled “The Current State of the Struggle Nobel The of the Nobel Prize Scholar the of medical that the of the of in a has also been and the to be by Nobel The of the Nobel Prize and effectiveness research in the been a by the US National Institutes of Health The PubMed Scopus Google National Institutes of Health for Medical US of and Scholar and the of of in Health a for the National Scholar by the US Agency for Healthcare Research and Quality health-care research for Healthcare Research and Quality the health Agency for Healthcare Research and Quality Scholar the and goals of the for Research and Translational and Translational can the and of and translational PubMed Scopus Google of National Institutes of Health and Translational and better health for the the three of the and Translational PubMed Scopus Google National and Translational the and translational research the of the National and Translational PubMed Scopus Google Scholar are transform the of biomedical research in the by the of discoveries into and to that of National Institutes of Health and Translational and better health for the the three of the and Translational PubMed Scopus Google Scholar definition that research the and of basic and the of the health of the translational for PubMed Scopus Google of these TS and priorities biomedical education of biomedical and treatment not the value of a in the medical and health and the of rigorous education for the of health that in and health an of TS of and and priorities are the contribution of medical education to health-care medical education (SBME) biomedical SBME contributes to TS when the from the education laboratory and in to better health-care and patient its biomedical Medical education research translational PubMed Scopus Google D the impact of translational patient PubMed Scopus Google Scholar SBME TS for that of by medical to achieved in the laboratory of simulation-based learning to the of in a medical PubMed Scopus Google Scholar to improved patient-care practices success Simulation-based learning in a medical PubMed Scopus Google Scholar and improved patient outcomes an in medical ICU to the educational intervention of simulation-based education to PubMed Scopus Google Scholar of translational outcomes from SBME include and of simulation-based PubMed Scopus Google that educational to rigorous of of simulation-based medical PubMed Scopus Google and expressed from simulation-based education for in a medical PubMed Scopus Google ScholarThe science of health education three of the TS in an and of and health individuals and science that of practice and the and of in and PubMed Scopus Google Scholar rigorous and the of from the of of of and of Google Scholar are for the of and to of practice and the and of in and PubMed Scopus Google Scholar science the of and of and research and patient different from traditional education of and a patients, to a of The evidence that SBME has of the to individuals and curriculum that the educational addresses and and of simulation-based medical education PubMed Scopus Google Scholar effectiveness that SBME practice to traditional education for the of simulation-based medical education practice better results traditional of the PubMed Scopus Google an definition of a in to patient PubMed Scopus Google Scholar medical and the of that medical not into the of health-care to patient PubMed Scopus Google Scholar that health-care TS from and educational research that are thematic, sustained, and research not only include and but also implementation science the biomedical of T2 and T3 research. a and also the of an in its The its research “the of to the of research and evidence-based practices into and to the and effectiveness of the of and Scholar the of and of improved and can be Scholar and to health-care and of and that health-care and In and addresses the science of health-care endorse the of for patient and patient and The science of research into practice in PubMed Scopus Google Scholar “The health and from to the of health a “The research community to that of the are in the science of delivery, and to such research are science the and complex of The science of research into practice in PubMed Scopus Google by a of in the by of for complex policy Health PubMed Scopus Google a Google Scholar that and of an educational intervention such an SBME curriculum to patient that in a an a complex service intervention are to and and and of and at in to to to and and that are in of a of for complex policy Health PubMed Scopus Google are grounded that service to to simulation-based to better and patient-care in care: simulation-based in patient 2008; 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The traditional TS definition involves research that progresses from bench to bedside in three phases. T1 science involves basic laboratory discoveries in the biomedical sciences. T2 science aims to produce evidence of T1 effectiveness at the individual patient level, compare the success of different treatments to identify “the right treatment for the right patient in the right way at the right time,” and translate these results into practice guidelines for patients, clinicians, and policy makers.1Dougherty D Conway PH The “3T's” road map to transform US health care: the “how” of high-quality care.JAMA. 2008; 299: 2319-2321Crossref PubMed Scopus (279) Google Scholar T3 science addresses health-care delivery, community engagement, and preventive services that produce measureable improvements in the health of individuals and society.1Dougherty D Conway PH The “3T's” road map to transform US health care: the “how” of high-quality care.JAMA. 2008; 299: 2319-2321Crossref PubMed Scopus (279) Google Scholar The biomedical TS imperative has been expressed for at least a century. In his 1905 Nobel Prize lecture titled “The Current State of the Struggle Nobel The of the Nobel Prize Scholar the of medical that the of the of in a has also been and the to be by Nobel The of the Nobel Prize Scholar TS and effectiveness research in the been a by the US National Institutes of Health The PubMed Scopus Google National Institutes of Health for Medical US of and Scholar and the of of in Health a for the National Scholar by the US Agency for Healthcare Research and Quality health-care research for Healthcare Research and Quality the health Agency for Healthcare Research and Quality Scholar the and goals of the for Research and Translational and Translational can the and of and translational PubMed Scopus Google of National Institutes of Health and Translational and better health for the the three of the and Translational PubMed Scopus Google National and Translational the and translational research the of the National and Translational PubMed Scopus Google Scholar are transform the of biomedical research in the by the of discoveries into and to that of National Institutes of Health and Translational and better health for the the three of the and Translational PubMed Scopus Google Scholar definition that research the and of basic and the of the health of the translational for PubMed Scopus Google Scholar of these TS and priorities biomedical education of biomedical and treatment not the value of a in the medical and health and the of rigorous education for the of health that in and health an of TS of and and priorities are the contribution of medical education to health-care delivery. 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Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? 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Back to table of contents Previous article Next article CommentaryFull AccessMental Health Response to the COVID-19 Outbreak in ChinaJunying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Junying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Published Online:7 May 2020https://doi.org/10.1176/appi.ajp.2020.20030304AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Transmission of the 2019 novel coronavirus (COVID-19) (1) has now widely and rapidly spread around the world. On March 11, 2020, the World Health Organization announced that COVID-19 is a pandemic (2). The rapid transmission and mortality risk of the COVID-19 infection may increase the risk of mental health problems among healthy individuals in the general public and worsen preexisting psychiatric problems in psychiatric patients, although data are still being gathered. A constellation of difficult feelings and psychological distress, including panic, worries, and depression, could be triggered by the fear of possible infection, being quarantined at hospitals and home, social isolation, and even the shortage of protective gear.A number of mental health surveys associated with the COVID-19 outbreak are being conducted in different vulnerable populations, which include infected patients, medical staff, students, and the general population. Liu et al. have reported results from a multicenter survey conducted among 1,563 medical staff members and found that the prevalence of depression and anxiety was 51% and 45%, respectively (3). So far, data on the mental health repercussions of the COVID-19 pandemic in outpatient populations have not been available. Thus, we conducted a questionnaire survey, from February 25 to March 9, 2020, among outpatients who sought care in the Departments of Psychiatry, Neurology, and Sleep Medicine in West China Hospital of Sichuan University (Chengdu, China). A self-report questionnaire was completed by outpatients, who provided consent, via the WeChat-based survey program Questionnaire Star. A total of 2,065 out of 3,441 patients completed the survey, including 589 new patients and 1,476 existing patients. The prevalence rates of mental health problems related to the COVID-19 outbreak, including anxiety (defined as a total score ≥5 on the Generalized Anxiety Disorder 7-item scale), depression (defined as a total score ≥5 on the Patient Health Questionnaire 9-item scale), and insomnia (defined as a total score ≥8 on the Insomnia Severity Index), were 25.5%, 16.9%, and 26.2%, respectively. Furthermore, 20.9% of patients (N=300) with preexisting psychiatric disorders (N=1,434) reported a deterioration of their mental health condition related to the pandemic. In particular, transportation restrictions, isolation at home, and fear of cross-infection in hospitals have inevitably become major concerns and barriers to treatment for these patients during the outbreak. Our survey also showed that 24.5% of new patients, including those with anxiety (N=46), depression (N=37), insomnia (N=79), and psychosis (N=21), could not receive timely diagnoses and treatment. Similarly, 22.0% of existing patients with diagnosed mental disorders, including depression, bipolar disorders, and schizophrenia (N=315), could not receive routine psychiatric care because of suspended hospital visits. Consequently, 18.1% of patients (N=259) have self-reduced medication dosages, and 17.2% of patients (N=247) stopped taking their medication because they could not gain access to prescriptions from physicians during the outbreak. As the lifetime prevalence of mental disorders is 16.6% among adults in China (4), millions of psychiatric patients may face barriers to help seeking for timely management of their mental health condition. The long-term repercussions of the viral pandemic on the management of psychiatric patients warrant further investigation. Nonetheless, our data reiterate the importance of implementing appropriate mental health care measures in the face of the COVID-19 pandemic.In response to the COVID-19 outbreak, there have been ongoing measures and concerted efforts in China that emphasize the importance of dealing with the potentially concurrent mental health crisis. On January 26, 2020, the National Health Commission of China released principles for emergency psychological crisis intervention for the COVID-19 pandemic (5). Mental health hotlines were quickly established across China and provided the public with counseling and psychological services. The telephone and Internet have been widely used to deliver mental health care services, and social media platforms (e.g., WeChat, Weibo) have been used to share strategies, guidelines, and education programs for managing potential mental distress. In addition, a series of self-help handbooks for psychological care associated with COVID-19 have been published by the China Association for Mental Health, medical institutions, and universities.Furthermore, a number of hospitals in China have initiated telemedicine services for patients in need during the outbreak of COVID-19. On January 26, 2020, West China Hospital of Sichuan University, as one of the leading hospitals in China, opened a free online outpatient service involving more than 100 medical doctors across specialties. This online outpatient service was created mainly to provide prescriptions to existing patients and to offer consultation to new patients. Our hospital collaborated with commercial courier services to deliver medication to patients' homes at no cost. To date, thousands of patients have received health care provided by this online outpatient service. Interestingly, only 7.4% of patients with mental disorders (N=136) in our survey have sought online help for medical care. Thus, there is a need to promote online mental health care services across China to manage mental health problems during the pandemic.The long-term outcomes of the mental health interventions in both community and hospital settings need further evaluation to determine how we can ameliorate the negative effects of viral outbreaks in the general public, especially among vulnerable patients with mental health problems.Sleep Medicine Center (Zhou, Xue, Tang), Department of Anesthesiology, Translational Neuroscience Center (Liu), and Outpatient Department (Yang), West China Hospital, Sichuan University, Chengdu, China.Send correspondence to Dr. Zhou ([email protected]).The authors report no financial relationships with commercial interests.The authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan University.References1 Lu R, Zhao X, Li J, et al.: Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395:565–574Crossref, Medline, Google Scholar2 World Health Organization (WHO): WHO director-general's opening remarks at the media briefing on COVID-19: 11 March 2020 (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020)Google Scholar3 Liu S, Yang L, Zhang C, et al.: Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020; 7:e17–e18Crossref, Medline, Google Scholar4 Huang Y, Wang Y, Wang H, et al.: Prevalence of mental disorders in China: a cross-sectional epidemiological study. 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the COVID-19 Pandemic in January 2022 | Journal of Sciences, Vol. No. in the and COVID-19 among patients with psychiatric illness A study from of Psychiatry, Vol. No. on Impact of COVID-19 Pandemic on with their and with Social Psychiatry, Vol. No. and of to Department during COVID-19 Pandemic of December 2021 | Journal of Care Medicine, Vol. 25, No. impact of the COVID-19 pandemic on depression in a prospective cohort December 2021 | Medicine, Vol. impact in patients with mental disorders after of COVID-19 Vol. to the COVID-19 Pandemic Among the General February 2021 | Journal of and Studies, Vol. No. 8The impact of COVID-19 pandemic on symptoms and among patients with medication a cross-sectional May 2021 | The Journal of and Vol. 22, No. reactions and insomnia in adults with mental health disorders during the COVID-19 January 2021 | BMC Psychiatry, Vol. 21, No. and anxiety symptoms in adults before and during the COVID-19 pandemic: evidence from a September 2021 | Annals of General Psychiatry, Vol. No. 1Prevalence of psychiatric and related symptoms among patients with COVID-19 during the wave of the April 2021 | and Health, Vol. 17, No. anxiety, and post-traumatic stress symptoms and COVID-19 patients: a cross-sectional study4 May 2021 | Middle East Current Psychiatry, Vol. No. of a of patients with disorders during the first COVID-19 December 2021 | Scientific Reports, Vol. 11, No. 1Effects of COVID ‐19 pandemic on mental health outcomes in a cohort of early psychosis January 2021 | in Psychiatry, Vol. No. the psychological therapy treatment outcomes for adults who are not in of and be to November 2021 | Medicine, Vol. Health to Social During the COVID-19 Pandemic in a November 2021 | Frontiers in Public Health, Vol. between the COVID-19 and and symptoms in people with November 2021 | impact of and mental health on health during of Psychiatric Research, Vol. and of public health on public new A systematic March 2021 | International Journal of Social Psychiatry, Vol. 67, No. and disorders associated with COVID-19. disorders and Vol. of mental disorders on COVID-19 October 2021 | Neurology, Vol. 13, No. of COVID-19 pandemic on emergency community Psychiatry, Vol. and psychological impact of COVID-19 pandemic in a cohort study Vol. mental health and need for care among psychiatric outpatients during the COVID-19 pandemic: from an in Research, Vol. pandemic in January 2021 | Journal of Social and Vol. 23, No. Psychiatric and the of Mental during the COVID-19 Pandemic: A et la de la COVID-19: January 2021 | The Journal of Psychiatry, Vol. No. Media and Analysis during the Covid-19 September 2021 | Vol. 13, No. Distress During the COVID-19 Pandemic in Patients Mental August 2021 | Frontiers in Psychology, Vol. to Analysis of the of July 2021 | Vol. 13, No. of COVID-19: of and July 2021 | No. 29, of Health for the of July 2021 | Frontiers in Health, Vol. of the Patients in Hospital to the COVID-19 A July 2021 | Frontiers in Psychology, Vol. during the COVID-19 pandemic social July 2021 | Vol. No. COVID-19 in Chinese July 2021 | Frontiers in Medicine, Vol. experiences of and mental health services during the first Covid-19 of Health Vol. 9, No. Health and during the Pandemic in A Questionnaire of Mental Health and Psychiatric July 2021 | International Journal of Research and Public Health, Vol. No. of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a of Affective Disorders, Vol. and Association of Life Among of Patients Psychiatric Services During the COVID-19 June 2021 | Frontiers in Psychiatry, Vol. of Anxiety to the COVID-19 Ph.D., Yang, Ph.D., Ph.D., Ph.D., Ph.D., Yang, Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., Ph.D., M.D., Ph.D., April 2021 | Journal of Psychiatry, Vol. No. in depression & anxiety among mental health service during the COVID-19 pandemicJournal of Affective Disorders, Vol. symptoms and seeking during the Covid-19 May 2021 | Translational Psychiatry, Vol. 11, No. und und February 2021 | der Vol. No. prevalence of depressive and anxiety symptoms and their associations with quality of life among patients with psychiatric disorders during the COVID-19 January 2021 | Translational Psychiatry, Vol. 11, No. COVID-19 pandemic and mental of The Vol. of COVID-19 pandemic on the mental health of May 2021 | Journal of associated with mental health and quality of life during the COVID-19 pandemic in May 2021 | Open, Vol. No. and risk of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: from the COVID-19 mental health April 2021 | Medicine, Vol. in The impact of protective and on and Medicine in Psychiatry, Vol. COVID-19 the of March 2021 | Current Psychiatry Reports, Vol. 23, No. Medicine in Psychiatry in the COVID-19 era: the impact of the pandemic on mental Medicine in Psychiatry, Vol. and in the age of October 2020 | Psychology & Vol. No. in mental health problems related to COVID-19 in Hospital Psychiatry, Vol. mental health and novel coronavirus: The risk of the Journal of Psychiatry, Vol. for and Mental On the of COVID-19 February 2021 | Frontiers in Vol. of during COVID-19: a an January 2021 | Vol. 44, No. and psychological of students during the early stage of COVID-19 outbreak in China: a cross-sectional February 2021 | BMJ Open, Vol. 11, No. an to Mental Health, and among Youth and February 2021 | International Journal of Research and Public Health, Vol. No. in the and of Mental Health November from July Disorders, and and mental illness: A systematic review and & Health, Vol. and in pandemic: the in mental health October 2020 | International Journal of Vol. No. 1Prevalence and with Insomnia Among the Chinese General Public the 2019 June 2021 | and of Vol. the of December 2021 | and of Vol. Health for to Patients in a of Pandemic: and of Patient July 2021 | Mental Health, Vol. 8, No. impact of COVID-19 pandemic on the of depression among health care cross-sectional May 2021 | Vol. Mental Health the of in the April 2021 | Journal of Education in the Health Vol. No. from November to the Mental Health of by COVID-19 in China: A December 2020 | Frontiers in Psychiatry, Vol. of in 100 Patients Disorder During the COVID-19 Pandemic in December 2020 | Frontiers in Psychiatry, Vol. in of November 2020 | Current Psychiatry Reports, Vol. 22, No. adverse with during COVID-19 Journal of Psychiatry, Vol. of patients with Journal of Psychiatry, Vol. health response for and adolescents during the COVID-19 outbreak in Research, Vol. to COVID-19 to in and from a for Sleep in December 2020 | International Journal of Research and Public Health, Vol. 17, No. awareness of suicide during the October 2020 | Reports, Vol. No. of and health anxiety during COVID pandemic among of a psychiatric an Journal of impact of COVID ‐19 on individuals with disorders: A survey of individuals in the and the July 2020 | International Journal of Disorders, Vol. 53, No. and Distress COVID-19 Among University in the October 2020 | Frontiers in Psychiatry, Vol. pandemic and mental health review of the and Vol. and to the COVID-19 crisis in the of Psychiatric Research, Vol. of COVID-19 on Youth Mental Health, and A of and de la COVID-19 la de et adolescents un et July 2020 | The Journal of Psychiatry, Vol. No. Network Analysis of During the COVID-19 October 2020 | Frontiers in Psychology, Vol. of suicide during and after the COVID ‐19 September 2020 | World Psychiatry, Vol. 19, No. psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public A systematic review and Research, Vol. changes during COVID-19 and the potential A June 2020 | Journal of Health Psychology, Vol. 25, No. and July 2020 | Journal of Psychiatry, Vol. No. COVID-19-Pandemie die und Psychotherapie, Vol. No. 2019 (COVID-19) and Psychiatric in Anxiety and Journal of Medicine, Vol. 2, No. of COVID-19 on Mental Health in the September 2020 | Journal of Internet Research, Vol. 22, No. an Outpatient Psychiatric to During the COVID-19 Pandemic: A October 2020 | Journal of Internet Research, Vol. 22, No. disorders in people infected with the coronavirus September 2020 | Journal of Public Health, Vol. No. 4 July authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan April 2020 online May 2020 in 1 July 2020

PHYSICIAN scientists perform biomedical research ranging from fundamental molecular studies to clinical trials. As such, physician scientists have a pivotal role in the biomedical research enterprise. The foundation for physician scientist leadership in the subspecialty of anesthesiology is highly dependent on the success of young investigators as they develop independent careers involving basic and clinical investigation. Hence, a leading priority of anesthesiology must be to nurture the academic careers of physician scientists within the specialty.Over the past decade, during a period of budgetary expansion by the National Institutes of Health (NIH), the number of NIH grant applications from physicians, in contrast to the number of grant proposals from Ph.D. scientists, has been slow to increase. Likewise, growth in NIH awards to physicians working in anesthesiology departments has also been slow.1Junior clinical anesthesiology faculty across the country find their ability to develop NIH-funded research programs limited by inadequate or overly fragmented research start-up time and by inconsistent approaches to research mentoring. In concert, the recent abrupt decrease in rate of growth of NIH funding now threatens not only the pace of our progress, but survival of physician scientist activity within anesthesiology.Based on these observations, anesthesiology is at risk of losing its status as a respected academic discipline within the broader biomedical community. Based on historic analysis of periods of limited NIH budgets, critical analysis of anesthesiology research training programs relative to peer academic specialties,1and considering the forecasted continued high demand for clinical manpower in our academic medical centers, we present the case for radical change in our approach to training within the specialty. Although effective solutions will require significant sacrifice by all sectors of the specialty, we propose that modest steps are far too late and will no longer succeed. This article, while seeking to inform and educate, is above all a passionate call for decisive action.Interdependence between clinical insight, attention to disease conundrums, and formulation of basic research hypotheses has driven many key discoveries in biomedical science. Physician scientists are uniquely trained to work in the nexus where science is translated into practice and are playing a pivotal role as new opportunities surrounding the human genome and proteome mature.2–8Physician scientists also play a major role with federal agencies and legislators as advocates for directing scarce resources into key sectors of the biomedical research enterprise,9–11especially as new opportunities to improve human health emerge.Over the past 50 yr and for the foreseeable future, the NIH has been the dominant resource for peer-review funding in academic medicine. Most working in and around academic health care are aware of the recent decade-long NIH expansion12and are also acutely aware that this expansion has ended. The NIH budget increased at an unprecedented average rate of 15% from 1999 to 200313but only 2.7% in fiscal 2004.14–17Those closest to the budget process are predicting that NIH budget growth is likely to remain at less than 1% for the next few years and could even decrease.14,18,19The decrease in NIH budget growth rate will cause a significant reduction in the overall rate of funding of grant applications submitted for peer review.17‡This immediate decrease in award success rates is partly due to the necessity to manage and maintain out-year funding commitments made by the NIH to investigators and universities during the recent period of rapid growth.To determine the impact of this scenario, we examine the early 1990s, when funding rates decreased to an all-time low in the modern era.§Throughout the 1970s and most of the 1980s, aggregate funding rates (which include all revisions to a grant proposal) in most years were in the 30–40% range. Then, rather abruptly, budget cuts caused overall success rates to decrease from 35.7% in 1987 to 24.5% in 1989. Success rates reached a nadir in 1993 (23.5%), with new applications funded at a rate of only 17.9% to maintain competing continuation “renewal” success rates for established programs at a marginally tolerable level of 40% (i.e. , during this era, 60% of all funded investigators lost their funding at the point of competitive renewal at the end of the original funding period). Although overall success rates recovered to 30.5% by 1997, the prolonged period of extreme competition for financial support in the early 1990s had a decisive impact on physician scientist careers. Numerous studies identified an ominous national decline in the number of physician scientists participating in basic and clinical research from all medical specialties by the late 1990s,20–25and several well-cited editorials identified the decrease in the number of research-intensive physician scientists as a “crisis” for the nation's medical research infrastructure.26–28The number of M.D. applicants for NIH competing research project support decreased from 7,283 in 1994 to 6,338 in 1996,∥and the number of M.D. grants actually awarded per year remained relatively unchanged (1,792 in 1994, 1,787 in 1996).#What about anesthesiology? Table 1indicates that NIH funding to anesthesiology departments has steadily increased since 1975. At first glance, this increase in funding seems encouraging, especially considering it has kept up with the 12-fold increase in total NIH funding to all disciplines (absolute dollars, not inflation adjusted). However, the percentage of total NIH budget going to anesthesiology departments has remained flat, never reaching 1%, despite the fact that anesthesiologists represent 6% of the total medical workforce.1Before taking comfort in the fact that anesthesiology funding has not declined in terms of percentage of overall NIH funding, one must remember that many current NIH-funded investigators in anesthesiology departments are now relatively mature, and as we describe below, few young physician scientists are training in research to follow their senior faculty mentors. Perhaps most revealing is the fact that only 40% of the current 132 academic anesthesiology departments (defined at those with accredited residency programs) have even one NIH grant credited to a faculty member or trainee in their department. Therefore, anesthesiology departments have been and continue to be severely underrepresented in NIH funding relative to the rest of academic medicine.Over the past decade, well-described financial and manpower pressures in the clinical sector of our specialty have also grown,29,30no doubt causing anesthesiology departments in academic centers to limit their investments in new faculty seeking substantial research careers. This timing is unfortunate, because it resulted in our specialty missing an opportune time to capture vital ground in the academic landscape. Beyond performance of anesthesiology as “departments,” close examination of the funding activity of M.D. scientists within anesthesiology raises even greater concerns. Since 1996, the number of M.D. applicants for NIH grants across all specialties had recovered substantially from the impact of budget cuts earlier in the decade. In fact, by fiscal 2001, M.D. competing applications across all disciplines had increased by 26%.**Unfortunately, in anesthesiology, the growth in NIH applications during this time has not been sufficient to significantly increase the number of physician scientists working in our field. In 1999, anesthesiology M.D.s submitted 132 competing applications to the NIH, and 41 of these grants were awarded. In 2003, our peak year, 181 grants were submitted by M.D.s, and of these 57 were funded. In 2004, however, from 164 applications, only 35 new grants were funded (data provided by Alison Cole, Ph.D., Program Director, Anesthesia and Integrated Systems, National Institute of General Medical Sciences, National Institutes of Health, Bethesda, Maryland, written communication, March 2005).Hence, although anesthesiology research expanded proportionally to the growth in the NIH budget, we did not make progress in terms of our fractional proportion of NIH grants relative to other specialties or relative to the size of our academic workforce. Given we did not “make our move” during an unprecedented period of growth in biomedical science, during which the NIH budget nearly doubled in magnitude, how will anesthesiology physician scientists respond to another sustained period where overall NIH funding rates once again decrease to 25% (the pre-1997 period) and below? As we consider these serious issues, we will ask the specialty to consider extremely difficult solutions, remedies that only a few years ago would have been viewed as radical and impractical. Because the situation in which we find ourselves developed slowly over decades, it is naive to suggest that anything short of resolute action will allow us to move our specialty back into the sunlight, on a healthy direction toward distinction as a respected academic discipline in the broader community of biomedical science.It has been suggested that lagging NIH funding to anesthesiology departments is a Ph.D. versus M.D. issue. Perhaps Ph.D. or M.D./Ph.D. researchers have better success at receiving NIH funding than M.D. researchers; in this paradigm, basic science departments with large percentages of Ph.D. investigators might fare better than clinical departments in terms of NIH funding. However, data from the NIH do not support this hypothesis.28Although it is true there are more Ph.D. applicants competing for research support from the NIH “across the board” compared with M.D. applicants, a per capita comparison of success rates over time (1979–present) reveals that M.D. and Ph.D. applicants have roughly equal success rates††and obtain their first independent NIH grant (R01) at approximately the same age (42–44 yr).31However, the issue may be slightly more complex. Many M.D. researchers submit basic science laboratory-based proposals, and perhaps those receive the same funding rates as Ph.D. researchers; a recent study indeed suggests that clinical research proposals tend to do slightly less well in the NIH peer review process.32But because NIH statistics do not differentiate between types of research performed by M.D. researchers and the differences are fairly small, overall there seems to be general parity. Therefore, to increase NIH funding in a clinical department, increasing the overall number of faculty capable of applying for such awards is most important. However, as a final comment, clinical departments in medical schools are uniquely placed to provide translational (bench to bedside) research.32,33If Ph.D. researchers perform all research in a clinical department, translational projects might not be a priority or as effective; further, a disconnect between basic researchers and clinical faculty sometimes occurs.34Optimally, a blending of Ph.D., M.D./Ph.D., and M.D. researchers best facilitates translational projects.34–36Such collaborations require the presence of a cadre of trained physician scientists expert in perioperative medicine.Another possible reason for low NIH funding in anesthesiology might be a bias against anesthesiology grants. It is therefore reassuring to note that if one examines NIH Web sites comparing grants awarded to departments of anesthesiology with those from other medical specialties, NIH grant application funding rates are roughly equal. Between 2000 and 2002, success rates (defined as ultimate funding of a submitted grant, including all revisions) ranged between 27 and 29% for grants from anesthesiology compared with approximately 32% for all other departments (clinical and basic science) (data provided by Alison Cole, Ph.D., Program Director, Anesthesia and Integrated Systems, National Institute of General Medical Sciences, National Institutes of Health, Bethesda, Maryland, written communication, March 2005).Greater success rates tend to occur for individual K series training grant awards to junior faculty. K08/K23 proposals submitted from individuals residing in anesthesiology departments achieved 40–66% success rates in 1999-2002 compared with 30–60% for similar awards across the NIH.‡‡Unfortunately, the absolute numbers of K series training applications from all anesthesiology departments across the United States are astonishingly low, ranging between 9 and 20 total per year (table 2). Inspection of the funding patterns within the National Institute of General Medical Sciences (a NIH institute funding many research training grants in anesthesiology [T32 and it is that at from to the no bias because not slightly success rates occur for NIH grants awarded to anesthesiology departments compared with basic science departments , or clinical departments , the number of applications for NIH grants from anesthesiology junior faculty more to high medical and the of practice residency to such the high of medical have impact on trainee to this is not an anesthesiology and all the same medical is a for all new physicians to the of Medical the average medical in has been to decrease the number of care physicians, decrease of physicians in the and physician and in fact, the NIH has as an of physicians research despite high and its one might that a few more years of academic training is less for anesthesiologists than for those in other medical specialties anesthesiology research have the ability to in general anesthesiology for from a more faculty recent study that the of subspecialty training did not change when year to anesthesiology residency training in the of subspecialty training in anesthesiology may to other than of this is similar to is also that those going on to clinical such as critical or are only to year, most other Hence, although of medical anesthesiology from research the specialty is no perhaps better in this than other medical training in anesthesiology residency for more than of all This of in subspecialty training anesthesiology residency may at partly to the of that as a specialty, have placed on subspecialty as a for practice of anesthesiology relative to other clinical disciplines such as and where now in their clinical and academic steps to progress will require a of the of research in the specialty must the broader of clinical perioperative practice as such, not be limited to of and This the research disciplines we within the of the perioperative physician The of is that the clinical and basic science studies on in nearly all disease have to perioperative and care and the success of this research will be to the clinical care in this period of all perioperative be the of academic As such, our for careers in the best and clinical research in our universities within anesthesiology of to health care such as its application to and perioperative the role of in and many other The perioperative period is a time of human that be as a uniquely to of medical research time and a of science and the best of our to their on the of that how we success of our in of within discipline include of and In the case of research more when a critical of investigators a healthy competition for within a of The total of competitive grant funding from agencies such as the NIH is a to of the of research taking in our specialty relative to academic in As funding to anesthesiology departments only of the total NIH budget, our faculty represent approximately 6% of the medical workforce. that this is a of our work because general with a similar in academic of the NIH budget, more than the funding of to research if anesthesiology departments to at the same with other disciplines in major academic medical centers, our must also have the same and impact as research in all other is to note that of the best clinical and basic science research in anesthesiology is in that from all such as the of the Medical , of , , of the National of Sciences of the United States of , and to determine a is impact is to examine its impact the impact of medical research by the number of other the work in their research It be that the impact is not an of per it the impact of a in the broader of medicine. At the same because tend to be impact and are is the to the biomedical with their impact the impact of a of and with subspecialty Although it is to note that several anesthesiology subspecialty have impact compared with other it is that subspecialty have impact compared with those by the broader community of science and clinical medicine. by even the specialty as tend to be and far less by investigators and working the but are critical to the science within these a healthy between in the broader and subspecialty be the of our next of when applying the of and we would suggest that the relatively number of anesthesiologists have research careers as a been as in a of research with impact equal to the best faculty from other The key as in the number of NIH grants by anesthesiology is one of numbers of faculty with a to research remain in our This because it the and the of possible As a specialty, we must find a to the best and from medical in a that to research in our discipline and also for the to success in the competitive of academic is that anesthesiology departments are not training an number of capable of competing for NIH level funding. Given the recent of in clinical trained to research training has been of training for across medical specialties is the of NIH training grants grants research training in basic science, clinical science, or research and are not limited to is that to a research the for research in many individuals would not have been that early to research is for scientists be by the of programs for anesthesiology such as the success rates for series NIH awards are ranging between and including all of the total 132 current for Medical anesthesiology residency training had been awarded NIH-funded research training grants in (table increasing to by individual in in have been awarded to 41 have been awarded to general and have been awarded to number of anesthesiology of the total all subspecialty equal only of the our extremely low number of training grants be to a in numbers of not training grants for its general but rather its in research on clinical to training in subspecialty and subspecialty have significant research as a specialty, we have no to research during subspecialty of our have a research have such a in contrast to those of our peer anesthesiology has been slow to of most its subspecialty disciplines (i.e. , although by the of have been made in terms of training within anesthesiology our in and we have not a sufficient number of academic that could provide a to substantial numbers of physician scientists across the anesthesiology In our continue to and support the research of their subspecialty training programs and even continue to new with a that science and must be in the training of physicians, even for those academic leadership in these specialties, and are in their to continue and their subspecialty and these programs provide the that the academic of their NIH training grants are a general of research and activity at the of NIH grants remain the key of continued in research at the junior faculty The most K series awards in clinical departments include the basic science and clinical series awards are yr in require provide support research and also require the financial support and of a senior faculty with a NIH-funded research NIH not only the and or research and but also consider the of the including or funding and and for into independent research careers. As in the number of all K series grants awarded to anesthesiology departments in the United States far other the overall performance of the specialty in other types of NIH funding. our training are relative to the for subspecialty training of academic faculty in other specialties, the cause the number of proposals submitted to the NIH and other agencies by anesthesiology and junior faculty In we low in to the research of our at the of their peer specialties this as a critical time to not back research is our that as a specialty, have we have anesthesiology as a specialty that not research as in anesthesiology are because they and even require research training in basic or clinical anesthesiology not individuals capable of or even in applying for NIH K award funding as junior faculty As such, we and from medical in our as well as from faculty in and us and those on their that they consider anesthesiology to be in its to research training because of its of to subspecialty training with research has kept at of the best and medical those a M.D./Ph.D. from anesthesiology for their the it be that clinical subspecialty training of a number of our residency with research training at the would have a impact on the of our training programs other solutions to medical research within the residency of anesthesiology research proposals, and has the to the current direction of the academic of our specialty. As such, we suggest that the number of clinical be increased to include all of the in anesthesiology and and to in research must be to that these research are This suggested by academic anesthesiology at their in 2000 in the role of training in years it is more that such action would have a decisive as the support for NIH-funded research greater competition the specialties, and us to that we are at a point in our such to anesthesiology subspecialty training will the support of our and research are in all centers and will never for our must be a to new anesthesiology subspecialty training programs and to to all such because the of research and within our specialty will require a difficult The of research training are never will require a to seeking training grants and other opportunities at across the United with support from medical we the that and high in the sector anesthesiology from taking these decisive including the such as not and even as has its subspecialty even clinical and research training research funding anesthesiology in all of the 20 NIH-funded medical centers in terms of total and federal research despite similar issues, competition from the and total faculty. It would to us that the issue is to of training that include a to academic of the specialty, not In fact, one could that as as anesthesiology to those seeking the most rapid to a medical we will continue to remain we to our peer to academic these steps may difficult to for many to we are seeking only the level of in our specialty that nearly all other specialties in academic demand of that anesthesiology subspecialty training with at yr of research in all anesthesiology by include a anesthesiology, and critical care as well as anesthesiology, anesthesiology, and It is the individual or in for training in and as such, the academic leadership of other medical specialties require this training from those to their call on the of and the of as well as other academic anesthesiology to this change and change in training is if our specialty is to and maintain and within the of academic medicine. the that this is the most in anesthesiology to that our specialty as a in the of academic medicine. that our is partly by our with academic careers and to and working at the between anesthesiology and the and in the that there are many anesthesiology faculty have had no subspecialty residency training and have in all also that although we make a case in support of expanded we are in the end an that to be to consider our in of other for and to for these the and at the of the that only a of are in their when one of the practice of will be as make one a a a to a and a of as and as well to the of that by the of our specialty will of our to leading of the not only change but perhaps also of back the of medical science in our perioperative M.D. of for Alison Cole, Ph.D. Director, Anesthesia and Integrated Systems, National Institute of General Medical Sciences, National Institutes of Health, Bethesda, for of funding and Medical for

Previous article Next article Non-Parametric Estimation of a Multivariate Probability DensityV. A. EpanechnikovV. A. Epanechnikovhttps://doi.org/10.1137/1114019PDFBibTexSections ToolsAdd to favoritesExport CitationTrack CitationsEmail SectionsAbout[1] Emanuel Parzen, On estimation of a probability density function and mode, Ann. Math. Statist., 33 (1962), 1065–1076 MR0143282 0116.11302 CrossrefGoogle Scholar[2] Murray Rosenblatt, Remarks on some nonparametric estimates of a density function, Ann. Math. Statist., 27 (1956), 832–837 MR0079873 0073.14602 CrossrefGoogle Scholar[3] G. M. Manija, Remarks on non-parametric estimates of a two-dimensional density function, Soobšč. Akad. Nauk Gruzin. SSR, 27 (1961), 385–390 MR0143303 Google Scholar[4] E. A. Nadaraya, Estimation of a bivariate probability density, Soobshch. Akad. Nauk Gruz. SSR, 36 (1964), 267–268 Google Scholar[5] R. E. Bellman, , I. Glicksberg and , O. A. 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No AccessEducationJul 2010Design Thinking for Social InnovationAuthors/Editors: Tim Brown, Jocelyn WyattTim BrownSearch for more papers by this author, Jocelyn WyattSearch for more papers by this authorhttps://doi.org/10.1596/1020-797X_12_1_29SectionsAboutView ChaptersPDF (0.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Designers have traditionally focused on enchancing the look and functionality of products. 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innovation of health technology assessment methods: the IHTAM frameworkInternational Journal of Technology Assessment in Health Care, Vol.38, No.131 January 2022The contribution of Design Thinking to the R of R&D in technological innovationR&D Management, Vol.52, No.15 May 2021Stakeholder Power Analysis of the Facilitators and Barriers for Telehealth Solution Implementation in China: A Qualitative Study of Individual Users in Beijing and Interviews With Institutional StakeholdersJMIR Formative Research, Vol.6, No.119 January 2022Design Thinking, a Novel Approach for an Effective and Improved Educational System–A ReviewInternational Journal of Professional Development, Learners and Learning, Vol.4, No.1Design Thinking for Technology Supporting Individuals With Neurodevelopmental Disorders in Developing CountriesSystems Thinking: Practical Insights on Systems-Led Design in Socio-Technical Engineering Systems31 July 2022Campaigning30 August 2022User-Centered Design2 September 2022Description of the Metamodel16 September 2022A Generic Framework for BIM Component Naming2 September 2022System Driven Design Industry: The Challenge Towards a Collective Vision for All Stakeholders in Design6 November 2022Un-learning/Re-learning: Towards Pluriversal Co-design6 November 2022Engaging Serious Games for Energy Efficiency25 November 2022Dynamic geographical accessibility assessments to improve health equity: protocol for a test case in Cali, ColombiaF1000Research, Vol.1128 November 2022Partnership for High Social Impact in Africa: A Conceptual and Practical Framework17 November 2022Using Human-Centered Design to Develop an Innovative Teen Pregnancy Prevention Program: Lessons Learned from a Case StudyCreative Education, Vol.13, No.04Disruptive social manufacturing models: lessons learned from Ferrari cars and Isinnova networks for a post-pandemic value creation pathProduction Planning & Control, Vol.12 December 2021Systemic design in the Australian Taxation Office – Current practice and opportunitiesAustralian Journal of Public Administration, Vol.80, No.45 October 2021THE INFLUENCE OF DESIGN THINKING ON OPEN INNOVATIONInternational Journal of Innovation Management, Vol.25, No.1027 October 2021Urban Informatics in the Science and Practice of PlanningJournal of Planning Education and Research, Vol.41, No.427 August 2018Integrating human‐centred design into the development of an intervention to improve the mental wellbeing of young women in the perinatal period: the Catalyst projectBMC Pregnancy and Childbirth, Vol.21, No.15 March 2021Using a human-centred design approach to develop a comprehensive newborn monitoring chart for inpatient care in KenyaBMC Health Services Research, Vol.21, No.124 September 2021Approaching Sustainability Transition in Supply Chains as a Wicked Problem: Systematic Literature Review in Light of the Evolved Double Diamond Design Process ModelProcesses, Vol.9, No.1226 November 2021Using design thinking to cultivate the next 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A Socially Responsible 3D Printed One-Handed RecorderInternational Journal of Environmental Research and Public Health, Vol.18, No.2220 November 2021Higher Perceived Design Thinking Traits and Active Learning in Design Courses Motivate Engineering Students to Tackle Energy Sustainability in Their CareersSustainability, Vol.13, No.2214 November 2021On-Site Construction Quality Inspection Using Blockchain and Smart ContractsJournal of Management in Engineering, Vol.37, No.6A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UKBMJ Open, Vol.11, No.112 November 2021Design and development of Air to Water Generator for the Village in Kerala, IndiaMaking sense of design thinking: A primer for medical teachersMedical Teacher, Vol.43, No.1026 January 2021Innovating at the nexus of world languages and cultures and design thinkingPedagogies: An International Journal, Vol.16, No.48 March 2021Knowledge interoperability and re-use in Empathy Mapping: an ontological approachExpert Systems with Applications, Vol.180Outcomes of Community-Based Youth Empowerment Programs Adopting Design Thinking: A Quasi-Experimental StudyResearch on Social Work Practice, Vol.31, No.722 March 2021De candidato a pós-graduando em Design no Brasil: mapeamento da jornada do usuário1 October 2021Sustainable solution to address waste management and energy challenges in rural IndiaAddressing Sanitation and Health challenges in rural India through socio-technological interventions: A Case Study in OdishaGuest editorialEuropean Journal of Marketing, Vol.55, No.920 September 2021Designing food experiences for well-being: a framework advancing design thinking research from a customer experience perspectiveEuropean Journal of Marketing, Vol.55, No.927 May 2021An innovation intermediary for Nairobi, Kenya: Designing student-centric services for university-industry Journal of Science, Technology, Innovation and Development, Vol.13, August the of service in tourism and Vol.31, August Research A Design Thinking Approach to on Journal of Environmental Research and Public Health, Vol.18, September Innovation Design and Sustainability of in Vol.13, No.173 September of in the design thinking of a Skills and Creativity, Sosyal August 2021Design thinking and innovation: the of Business July 2020Design thinking approach to for the Journal of August Uygulamaları Bilimler August 2021Innovating for through collaborative innovation of Cleaner Production, OF DESIGN AND OF AND of the Design Society, July of Social Innovation through The Case of in Vol.13, August COVID-19 as a for public and The need for robust governance to turbulent Management Review, Vol.23, September and practice of Design Thinking: of and business Journal of Design Creativity and Innovation, Vol.9, May Learning to Support Decision-Making and Creative in Instructional Design Vol.65, No.46 April in Learning through the of Design Thinking in a Vol.13, July methodology design: participatory processes for of Research, a approach to food as in Student case of using a to support Technology as an The and of in Regional Open Innovation Vol.13, June Services during the in of Design, December 2022Supporting and Living through Journal of Environmental Research and Public Health, Vol.18, April de Vol.26, the new on the in public & a April of Design Thinking to in a Vol.13, April Courses of Design on the Light on to Social and Vol.13, April 2021Using human-centred design to develop an female Vol.7, January case study of an of Business No.214 May Innovation in Education and Social Service and Approaches to Social in Education, March Design Thinking Approach for March to the of energy in Research & Social Science, A Conceptual Framework for the and of Youth of and Health, Vol.18, evaluation of innovation: A case of for in Journal of Science, Technology, Innovation and Development, Vol.13, July Novel for Digital Assessment Using A Human-Centered Design Approach (Preprint)JMIR February mental health and in and mental framework for in of Cleaner Production, to Design Thinking to Creative and in Journal of & Design Education, August Theory in An Journal, March 2021Designing and for with January with design thinking: a case study from Journal of Environmental Education, Vol.52, January and the of Design: of Design and Design in No.122 May to Design with A for Design and July Case and the of Design Thinking in Public Education in August to Co-Created Digital to Support Activities for Socially Youth in February Innovation and Exchange a Lessons Learned from a Design Thinking Challenge in May October Sustainable Business and January Analysis of Agile Development Methodology Through Design June Sustainable Design to Environmental of Design November Case for Design May Learning in Design Thinking to April 2021Design Thinking as a Strategy to Learning in Education Across South April Inspection Management with October design methodology for A to community health and health in the Health of and Science, Vol.5, February 2021Using Design Thinking to the Educational of August factors of service design methodology for manufacturing Business & Management, Vol.8, February 2021Design and of an app for September 2021Design Innovation Methodology – Design in Journal, of the Health Mental Health Intervention for in and for a Research Vol.10, June Design Approach to Social a of Public and October Design Thinking in an Interdisciplinary Learning December Design Thinking to Design Thinking to Food Innovation for January of Design Thinking and to Food and January 2021Design Thinking to Engage in Food The January 2021Systemic and Design Towards Participatory The Journal of Design, and Innovation, Vol.7, Design Thinking October Research and Design Thinking for the Health and Social A para de de Vol.16,

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of North American (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists, and dermatologists in North America. It is important to realize that guidelines cannot always account for individual variation among patients. They are assessments of current scientific and clinical information provided as an educational service; are not continually updated and may not reflect the most recent evidence (new evidence may emerge between the time information is developed and when it is published or read); should not be considered inclusive of all proper treatments methods of care, or as a statement of the standard of care; do not mandate any particular course of medical care; and are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Whether and the extent to which to follow guidelines is voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances. Although IDSA, AAN, and ACR make every effort to present accurate, complete, and reliable information, these guidelines are presented “as is” without any warranty, either express or implied. IDSA, AAN, and ACR (and their officers, directors, members, employees, and agents) assume no responsibility for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with these guidelines or reliance on the information presented. The guidelines represent the proprietary and copyrighted property of IDSA, AAN, and ACR. Copyright 2020 Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology. All rights reserved. No part of these guidelines may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of IDSA, AAN, or ACR. Permission is granted to physicians and healthcare providers solely to copy and use the guidelines in their professional practices and clinical decision-making. No license or permission is granted to any person or entity, and prior written authorization by IDSA, AAN, or ACR is required, to sell, distribute, or modify the guidelines, or to make derivative works of or incorporate the guidelines into any product, including but not limited to clinical decision support software or any other software product. Except for the permission granted above, any person or entity desiring to use the guidelines in any way must contact IDSA, AAN, or ACR for approval in accordance with the terms and conditions of third party use, in particular any use of the guidelines in any software product. Summarized below are the 2020 recommendations for the prevention, diagnosis, and treatment of Lyme disease. The panel followed a systematic process used in the development of other Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text (http://onlinelibrary.wiley.com/doi/10.1002/acr.24495/abstract). A. Personal protective measures B. Repellents to prevent tick bites C. Removal of attached ticks A. Diagnostic tick testing B. Diagnostic testing of asymptomatic patients following tick bites Supplementary data. Supplementary materials (in addition to the full guideline) are available on the Arthritis Care & Research website at http://onlinelibrary.wiley.com/doi/10.1002/acr.24495/abstract. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author. Conflict of interest statement. See the Methodology section in the full guideline (on the Arthritis Care & Research website at http://online​library.wiley.com/doi/10.1002/acr.24495/abstract) for approach to conflict of interest (COI) by the IDSA/AAN/ACR COI review group. The following list is a reflection of what has been reported to the IDSA/AAN/ACR COI review group. To provide thorough transparency, the IDSA/AAN/ACR requires full disclosure of all relationships, regardless of relevancy to the guideline topic. The assessment of disclosed relationships for possible COI is based on the relative weight of the financial relationship (i.e., monetary amount) and the relevance of the relationship (i.e., the degree to which an association might reasonably be interpreted by an independent observer as related to the topic or recommendation of consideration). The reader of these guidelines should be mindful of this when the list of disclosures is reviewed. Dr. Lantos has received research funding from the National Cytomegalovirus Foundation and from the NIH and educational funding from Duke University; and has served as a consultant and reviewed trial protocol for Frederick O’Connor Medical Consultants, LLC. Dr. Bockenstedt has received research funding from the NIH and the Gordon and Llura Gund Foundation; has received remuneration from L2 Diagnostics for investigator-initiated NIH-sponsored research; and was awarded an endowed professorship as the Harold W. Jockers Professor of Medicine at Yale University. Dr. Falck-Ytter serves as director of the Evidence Foundation and the GRADE Network; conducts GRADE workshops with the Evidence Foundation; has served as the chair of the Guidelines Committee for the American Gastroenterological Association; and has received research funding from the Cleveland VA Medical Research and Education Foundation. Dr. Aguero-Rosenfeld serves as a council member for the New York City chapter of the American Society of Microbiology (ASM) and as a Board member of the American Lyme Disease Foundation; has provided legal testimony and consultation regarding Lyme disease and tick-borne diseases; and has received research grants from the NIH, BioFire, New York State Department of Health, and ViraMed. Dr. Auwaerter receives research funding from the Fisher Center for Environmental Infectious Diseases and the NIH; serves on the Board of Directors of the American Lyme Disease Foundation and as the Vice Chair of the Infectious Diseases Society of America (IDSA) Foundation; serves as a scientific advisor for DiaSorin, Adaptive Technologies, and Shionogi; provides legal expert opinion testimony regarding Lyme disease; had stock in Johnson & Johnson; has served as an editor for Johns Hopkins POC-IT ABX Guide, an advisor for the Food and Drug Administration (FDA), Genentech, Dynavax, Aradigm, Cempra, BioMérieux, Cerexa, and Medscape; has received research funding from Cerexa; has served on the FDA Advisory Board, the Medscape Advisory Board, and the IDSA Board of Directors; and his spouse has equity interest in venture capital–funded Capricor. Dr. Belani reviews non-continuing medical education (CME) lectures for and received honoraria and travel reimbursement from Horizon Therapeutics; and has received research funding from the NIH and the Children’s Hospitals and Clinics of Minnesota. Dr. Bowie has provided expert testimony to the Canadian Senate Subcommittee on Bill C-442: An Act Respecting a National Lyme Disease Strategy on behalf of the Association of Medical Microbiology and Infectious Disease Canada; and has received research funding from GlaxoSmithKline, Pfizer Canada, the Canadian Institutes of Health Research, and Vancouver Coastal Health Research Institute. Dr. Branda receives research funding from the Lyme Disease Biobank Foundation and Zeus Scientific; serves as a scientific advisor and consultant to DiaSorin, Inc.; has served as a scientific advisor and consultant for T2 Biosystems; has served on the scientific advisory board of Roche Diagnostics and AdvanDx; has received research funding from Karius, Inc., Alere, Inc., T2 Biosystems, BioMérieux, TBS Technologies, Immunetics, Inc., DiaSorin, Inc., Kephera Diagnostics, Inc., and the Bay Area Lyme Foundation; has participated in unfunded research collaborations with Karius Inc. and Kephera Diagnostics; was a member of the editorial board of the Journal of Clinical Microbiology; was a co-inventor on an application for a patent to protect intellectual property; and his spouse is an employee of Informed DNA. Dr. Clifford receives research funding from the NIH and the Alzheimer’s Association; serves as scientific consultant to Inhibikase and Excision BioTherapeutics; serves on Data and Safety Monitoring Boards (DSMB) for Biogen, Genzyme/Sanofi, Genentech, EMD Serono, Shire, Wave Life Sciences, Pfizer, Atara, Mitsubishi Tanabe, and IQVIA (formerly Quintiles); serves on Progressive Multifocal Leukoencephalopathy (PML) adjudication committees for Amgen, GlaxoSmithKline, EMD Serono, Bristol Myers Squibb, Roche, and the Takeda Oncology (formerly Millennium) Adjudication Committee–FDA, as well as Dr. Reddy’s Laboratories; has previously received research funding from the NIH; and his spouse formerly held stock in Johnson & Johnson. Dr. DiMario has received research funding from Novartis. Dr. Halperin serves as an Editorial Board Member of Neurology, and Vice Chair of the American Academy of Neurology (AAN) Guideline Subcommittee; has stock in Abbott Labs, AbbVie, Merck, and Johnson & Johnson; provides and has previously provided legal expert testimony defending physicians in medical malpractice cases on various neurologic issues, including Lyme disease; has received research funding from NIH, the Centers for Disease Control and Prevention (CDC); and has served as a section editor of neuroinfectious diseases in Neurology & Neuroscience Reports. Dr. Krause receives research funding from the Yale Emerging Infections Program; receives remuneration from Gold Standard Diagnostics for a collaborative research project; has stock in Gilead Sciences and First Trust NASDAQ Pharmaceuticals ETF; has received research funding from the NIH, the Centers for Disease Control and Prevention (CDC), the Gordon and Llura Gund Foundation, and L2 Diagnostics for NIH-sponsored research; has served as a scientific consultant and provided medical education and training for Oxford Immunotec, Inc.; has a patent pending (Enhanced Chemiluminescent enzyme-linked immunosorbent assay for detection of antibodies against Babesia microti), for which US Provisional Patent Application No. 62/580,588, was filed on November 2, 2017; serves on the Board of Directors for the American Lyme Disease Foundation and the Editorial Boards of Pathogens and Plos Neglected Tropical Diseases and the Editorial Advisory Board of Clinical Infectious Diseases; was on the Editorial Board of Journal of Clinical Microbiology, and will be on the Editorial Board of Clinical Microbiology Reviews starting January 2021. Dr. Liang has stock in Johnson & Johnson; received research funding from the Veterans Health Administration, the Arthritis Foundation, and the NIH; has served on the FDA Advisory Panel, Institute of Medicine panels; served as a scientific reviewer for the Research Grant Council of Hong Kong and the NIH; served on the Board of the Lupus Clinical Trials Consortium, Beacon Hill Villages, and Rx Foundation and advised the Institute for Clinical and Economic Review and the China Medical Board; previously had stock in Sequenom; and his spouse has stock in Johnson & Johnson. Dr. Meissner is a current member of the CDC Workgroups and serves as a volunteer consultant on the American Academy of Pediatrics Committee on Infectious Diseases and the NIH DSMB. Dr. Nigrovic receives research funding from the NIH, Department of Defense, and the NIH Center for Research Resources and for Advancing Translational Sciences (NCATS), Global Lyme Alliance, and Peabody Foundation; serves on the Editorial Board for Annals of Emergency Medicine; has served as scientific consultant for Adaptive Technologies; has received research funding from the NIH, Provider and Payer Quality Initiative (PPQI) Research Foundation, Harvard Catalyst, Hood Foundation, Bay Area Lyme Foundation, CDC, Emergency Medical Services for Children (EMSC), the National Patient-Centered Clinical Research Network (PCORNet), Milton Foundation, and Boston Children’s Hospital. Dr. Nocton receives research funding from Bristol Myers Squibb; serves as a member of the Subboard of Pediatric Rheumatology of the American Board of Pediatrics; and has received research funding from AbbVie, NIH, and the Arthritis Foundation. Dr. Pruitt has received research funding from Teva Pharmaceuticals and has served on the AAN Editorial Board of Neurology Clinical Practice. Ms Rips has received research funding from the Center for AIDS Research, Biogen Idec, Hoffmann-LaRoche, Sun Pharmaceutical Industries Ltd., Genzyme, the Alzheimer’s Association, and the American College of Radiology; and has served as a speaker for Teva Pharmaceuticals. Dr. Rosenfeld serves as a Council Member of the American College of Cardiology; has stock in Abbott, Proctor & Gamble, and General Electric; has received Fellowship Support from Boston Scientific, Medtronic, and Abbott Laboratories (formerly St. Jude Medical); has received research funding from Boehringer Ingelheim Pharmaceuticals, Inc.; and has served on the Program Committee and the Patient and Caregivers Committee of the Heart Rhythm Society. Dr. Savoy serves on the American Academy of Family Physicians (AAFP) Board of Directors, as an ex-officio Board member of Delaware Academy of Family Physicians (DAFP), as the Chair of the Centers for Medicare and Medicaid Services (CMS) Advisory Panel on Outreach and Education, and as Secretary of the Board of Directors of the Association of Departments of Family Medicine; receives honoraria from AAFP, DAFP, CMS, and Merck; has served on an Advisory Council for Highmark Health and as an advisor to the AAFP Adolescent Immunization Project; has received honoraria from AAFP; has served as the President of DAFP, as Editor of DelFamDoc, and as a member of AAFP Commissions. Dr. Sood has received research funding from the NIH; and has provided expert testimony for Danaher Lagnese, PC. Dr. Steere receives research funding from the NIH and the Mathers Foundation; has received research funding from the NIH, the American College of Rheumatology, the Mathers Foundation, the English-Bonter-Mitchell Foundation, Immunetics, Inc., Zeus Diagnostics, and the Ounsworth-Fitzgerald Foundation; and has served as a scientific advisor for Baxter Bioscience Institute of Systems Biology, Immunetics, Inc., Roche Diagnostics, and Viramed. Dr. Strle receives research funding from the Slovenian Research Agency; serves as the Head of Health Counsel of the Ministry of Health of the Republic of Slovenia and as a member of the Steering Committee for the European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis; serves on the Roche Diagnostics Advisory Board on Lyme Disease Diagnostics; and has received honoraria from Roche Diagnostics. Dr. Sundel receives research funding from the NIH and AbbVie, Inc.; serves as a content author and editor for UpToDate; provides expert testimony to Chin-Caplan, PC; has provided expert testimony for Conway Homer, PC; has served as an advisor for Paul Hastings, LLC; has served as a content editor for SimulConsult and as a Medical Education Resources lecturer for CME-granting educational courses; has received remuneration from SimulConsult as a co-investigator for an NIH-sponsored grant; and has received research funding from the NIH. Dr. Tsao receives research funding from the National Science Foundation, NIH, CDC, the Michigan Lyme Disease Association, and the Michigan Department of Health and Human Services; serves as a Scientific Council Advisor Member for the Canadian Lyme Disease Research Network and as a scientific advisor for the American Lyme Disease Association; has received research funding from Michigan State University; has served as an Associate Editor for Ticks and Tick-Borne Diseases and on the Tick Vectors, Surveillance, and Prevention Subcommittee of the US Department of Health and Human Services Tick-Borne Disease Working Group; and has received remuneration for providing educational seminars for Boehringer Ingelheim (formerly Merial). Dr. Wormser receives research funding from Immunetics, Inc., Rarecyte, Inc., Institute for Systems Biology, and Quidel Corporation; serves on the Board of the American Lyme Disease Foundation; provides and has previously provided expert testimony in malpractice cases; has stock in AbbVie, Inc. and Abbott Laboratories; has received research funding from the CDC, NIH, BioMérieux, Bio-Rad Laboratories, and DiaSorin, Inc; has served as a scientific research advisor for Baxter International and as a Lyme disease advisor and expert for the Missouri Board of Registration for the Healing Arts; has a patent approved (US patent no. 10,669,567 B2) for High Sensitivity Method for Early Lyme Disease Detection; filed 2 patent applications related to early Lyme disease detection (application no: 62/277,252) and Lyme arthritis and post-treatment Lyme disease syndrome (application no: 62/725,745); and has served on the Editorial Boards for Clinical Infectious Diseases, Vector-Borne and Zoonotic Diseases, and Ticks and Tick-Borne Diseases. Dr. Zemel has served as an advisor for Novartis Promotional Speakers Bureau. No other disclosures relevant to this article were reported. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. The expert panel expresses its gratitude for thoughtful reviews of an earlier version to the external reviewers. The panel thanks the IDSA, AAN, and ACR for supporting the guideline development process. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. Dr. Lantos had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Lantos, Rumbaugh, Bockenstedt, Falck-Ytter, Aguero-Rosenfeld, Auwaerter, Baldwin, Bannuru, Belani, Bowie, Branda, Clifford, DiMario, Halperin, Krause, Lavergne, Liang, Meissner, Nigrovic, Nocton, Osani, Pruitt, Rips, Rosenfeld, Savoy, Sood, Steere, Strle, Sundel, Tsao, Vaysbrot, Wormser, Zemel. Lantos, Rumbaugh, Bockenstedt, Falck-Ytter, Aguero-Rosenfeld, Auwaerter, Baldwin, Bannuru, Belani, Bowie, Branda, Clifford, DiMario, Halperin, Krause, Lavergne, Liang, Meissner, Nigrovic, Nocton, Osani, Pruitt, Rosenfeld, Savoy, Sood, Steere, Strle, Sundel, Tsao, Vaysbrot, Wormser, Zemel. Lantos, Rumbaugh, Bockenstedt, Falck-Ytter, Aguero-Rosenfeld, Auwaerter, Baldwin, Bannuru, Belani, Bowie, Branda, Clifford, DiMario, Halperin, Krause, Lavergne, Liang, Meissner, Nigrovic, Nocton, Osani, Pruitt, Rips, Rosenfeld, Savoy, Sood, Steere, Strle, Sundel, Tsao, Vaysbrot, Wormser, Zemel. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. Wong N, Budoff M, Ferdinand K, Graham I, Michos E, Reddy T, Shapiro M and Toth P (2022) Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clinical practice statement, American Journal of Preventive Cardiology, 10.1016/j.ajpc.2022.100335, 10, (100335), Online publication date: 1-Jun-2022. Coller J, Gong F, McGrady M, Shiel L, Liew D, Stewart S, Owen A, Krum H, Reid C, Prior D and Campbell D (2021) Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure, ESC Heart Failure, 10.1002/ehf2.13695, 9:1, (196-212), Online publication date: 1-Feb-2022. Mittal M, McEniery C, Supramaniam P, Cardozo L, Savvas M, Panay N and Hamoda H (2022) Impact of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol on cardiovascular markers in women diagnosed with premature ovarian insufficiency or an early menopause: a randomised pilot trial, Maturitas, 10.1016/j.maturitas.2022.01.012, 161, (18-26), Online publication date: 1-Jul-2022. Adikari D, Gharleghi R, Zhang S, Jorm L, Sowmya A, Moses D, Ooi S and Beier S (2022) A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study, BMJ Open, 10.1136/bmjopen-2021-054881, 12:6, (e054881), Online publication date: 1-Jun-2022. 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Okami Y, Ueshima H, Nakamura Y, Kondo K, Kadota A, Okuda N, Ohkubo T, Miyamatsu N, Okamura T, Miura K and Okayama A (2021) Risk Factors That Most Accurately Predict Coronary Artery Disease Based on the Duration of Follow-up ― NIPPON DATA80 ―, Circulation Journal, 10.1253/circj.CJ-20-0739, 85:6, (908-913), Online publication date: 25-May-2021. Wilson R, Aminian A and Tahrani A (2021) Metabolic surgery: A clinical update, Diabetes, Obesity and Metabolism, 10.1111/dom.14235, 23:S1, (63-83), Online publication date: 1-Feb-2021. Steger A, Dommasch M, Müller A, Sinnecker D, Huster K, Gotzler T, Gotzler O, Hapfelmeier A, Ulm K, Barthel P, Hnatkova K, Laugwitz K, Malik M and Schmidt G (2020) Polyscore of autonomic parameters for risk stratification of the elderly general population: the Polyscore study, EP Europace, 10.1093/europace/euaa359, 23:5, (789-796), Online publication date: 21-May-2021. 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Sarfo F, Nichols M, Gebregziabher M, Tagge R, Asibey S, Jenkins C and Ovbiagele B (2019) Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy [EVERLAST]: Protocol for a prospective observational study, eNeurologicalSci, 10.1016/j.ensci.2019.100189, 15, (100189), Online publication date: 1-Jun-2019. van Bronswijk S, Lemmens L, Keefe J, Huibers M, DeRubeis R and Peeters F (2018) A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder, Depression and Anxiety, 10.1002/da.22868, 36:3, (252-261), Online publication date: 1-Mar-2019. Dimberg L, Eriksson B and Hashem M (2019) Myocardial infarction and death findings from a 22-year follow-up of a cohort of 980 employed Swedish men, Public Health, 10.1016/j.puhe.2019.07.006, 175, (148-155), Online publication date: 1-Oct-2019. Cifkova R (2019) Arterial Hypertension and Cardiovascular Risk Management of Hypertension, 10.1007/978-3-319-92946-0_3, (57-74), . Rojas C, Ramírez H, Salazar L, Kalergis A, Gálvez A and Escobar‐Vera J (2019) Characterization of LDLR rs5925 and PCSK9 rs505151 genetic variants frequencies in healthy subjects from northern Chile: Influence on plasma lipid levels , Journal of Clinical Laboratory Analysis, 10.1002/jcla.23001, 33:9, Online publication date: 1-Nov-2019. Kotalik A, Eaton A, Lian Q, Serrano C, Connett J and Neaton J (2019) A win ratio approach to the re-analysis of Multiple Risk Factor Intervention Trial, Clinical Trials, 10.1177/1740774519868233, 16:6, (626-634), Online publication date: 1-Dec-2019. An Y, Yun S, Yang I, Kim D and Yang D (2019) Predictive Performance of Ultrasound-Determined Non-Alcoholic Fatty Pancreas Disease Severity for Intermediate and High Risk of Coronary Heart Disease, Journal of the Korean Society of Radiology, 10.3348/jksr.2019.80.6.1190, 80:6, (1190), . Sakaki J, Melough M, Lee S, Pounis G and Chun O (2019) Polyphenol-Rich Diets in Cardiovascular Disease Prevention Analysis in Nutrition Research, 10.1016/B978-0-12-814556-2.00010-5, (259-298), . Gomez-Sanchez L, Gomez-Marcos M, Patino-Alonso M, Recio-Rodriguez J, Gomez-Sanchez M, González-Sánchez J, Alonso-Domínguez R, Sánchez-Aguadero N, Maderuelo-Fernandez J, Ramos R, Garcia-Ortiz L and Rodriguez-Sanchez E (2019) Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study, Medicina Clínica, 10.1016/j.medcli.2019.01.033, 153:9, (351-356), Online publication date: 1-Nov-2019. 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Anyone who has followed the popular television serial “Mad Men” knows that a product's name is an important focus of Madison Avenue. A bad outcome can tarnish a good name (e.g., the Chevrolet Corvair) while a bad name can tarnish a potentially good product (e.g., the Ford Edsel). Appealing names attached to excellent products can becomes iconic in the minds of the public and become inculcated into common language – examples being the Mustang and the Corvette. So what do automobiles have to do with science? I would argue that the translational science community has done a poor job of marketing our signature research program—translational science—and thus have confused the public, potential investors, donors, Congress and most importantly the next generation of physician-scientists. We would therefore do well to take a lesson from Madison Avenue and agree upon a single moniker for research that is focused on improving the health of our population. In May 1968, the Editor of the New England Journal of Medicine used the term “Bench-Bedside Interface” to describe two papers published in the issue that demonstrated for the first time that chronic granulomatous disease of childhood could occur in females.1 The concept that scientists, and in particular physician scientists, would try to understand the biology of clinical observations by pursuing studies in their laboratories or that they would identify new therapeutic targets or biomarkers in the laboratory which could then be evaluated in the clinic was not new. William Osler had built the School of Medicine at Johns Hopkins on the foundation that the clinics and the laboratories had to be inextricably linked and Lewellys Barker, Osler's successor as Director of Medicine at Hopkins, established the concept of the laboratory as a place where the underlying biology of disease could be determined and where new treatments could be developed. The concept that both physicians (clinical scientists) and basic scientists could produce important findings while working at the interface between basic science and clinical medicine persisted through the 20th century—but it lacked a name. In 1999 the NIH first established a funding mechanism for what they described as “bench-to-bedside” projects through the creation of what they referred to as “B2B” programs. (www.cc.nih.gov/ccc/btb/) Established by the Director of the Clinical Center, the B2B awards incentivized intramural basic scientists to collaborate with intramural clinical researchers in order to speed the translation of laboratory discoveries into new therapeutics. In 2006, the program was expanded to include partnerships between intramural and extramural clinical researchers: a large step for the NIH as it was the first time that a single award funded both intramural and extramural investigators. In 2004, a panel chaired by Edward J. Benz and Joseph L. Goldstein reported that: “The Bench-to-Bedside Awards program serves as a superb example of a highly successful program that fosters collaborations among intramural scientists and clinicians in areas of research that have the potential for improving understanding of an important disease process or for leading to a new therapeutic intervention.”2 However, the awards remained largely seed funding and the program modest with only 10 of 127 applications funded in 2013. Thus, the term “B2B” gained little attention or traction. With the human genome project well underway, scientists in the late 1990's began to conceptualize how completion of the project would lead to the ability to “personalize” medical regimens for individual patients based on either their own genotype (pharmacogenomics)3 or the genotype of their tumor.4 The completion of the human genome project in 2003 provided the scientific platform that would allow investigators to identify genetic causes for both rare and common diseases, understand the molecular basis of human diseases, identify molecular markers of risk and/or disease severity, uncover new therapeutic targets for either small molecules, biologics or gene therapy, and elucidate methods to individualize therapy based on an individual's genotype—the essence of “personalized medicine.” The use of “personalized medicine” to define a field of research continued to be used in the literature, but like B2B, it did not receive a great deal of attention from the public or from Congress. In fact, it wasn't until a 2010 Perspective in the New England Journal of Medicine entitled “The Path to Personalized Medicine,” by Margaret Hamburg, Director of the Food and Drug Administration and Francis Collins, Director of the NiH, that specific plans to enhance personalized medicine and to overcome the inherent obstacles needed to move personalized medicine from an esoteric vision to a reality were conceptualized.5 They pledged to “invest in advancing translational and regulatory science, better define regulatory pathways for coordinated approval of co-developed diagnostics and therapeutics, develop risk-based approaches for appropriate review of diagnostics to more accurately assess their validity and clinical utility, and make information about tests readily available.” Importantly, the central concept of their perspective was translation. Perhaps the failure of the term “personalized medicine” to gain traction has been attributable in part to the fact that genetic heterogeneity makes using genetic tests to predict disease occurrence imperfect, molecular diagnostics and biomarkers have been associated with false positives as well as false negatives, and results of gene therapy have been disappointing.8, 9 In 2005, research focused on human disease gained another new moniker with the announcement by Elias Zerhouni, the new Director of the NIH, of the creation of the Institutional Clinical and Translational Science Awards (CTSAs) program.10 It was designed to “foster productive collaboration among experts in different fields, lower barriers between disciplines, and encourage creative, new approaches that will help us solve complex medical mysteries” leading to improved human health.” Unlike past NIH funding programs, the CTSAs were multidimensional and multi-disciplinary as they incorporated the concept of “team science.” Translational medicine brought together basic scientists, physician scientists, biostatisticians, epidemiologists, nonphysician health care providers, computational biologists, informaticians, health care economists, healthcare economics and policy experts, biomedical engineers, ethicists, volunteers and regulators. These large teams of scientists also incorporated the talents of volunteers, educators, women's health groups, faith-based groups, community housing organizations, federally qualified health centers as well as behavioral scientists, sociologists, and health care attorneys. Thus, entire communities became involved in translational medicine. With a critical part of a CTSA being focused on education, the next generation of clinical and translational scientists became apostles of the new term “translational science.” The term “translational medicine” was not initially embraced by either academia or the lay public, but four events moved it into the basic language of medicine: (1) Steven Reis, Director of the Clinical and Translational Institute at the University of Pittsburgh, published an iconic figure that clearly defined translational medicine; (2) numerous journals were created in order to publish clinical and translational science including this journal and the highly prestigious Science Translational Medicine and at least 5 other new journals with “translational” in their names; (3) funding for CTSAs increased with nearly half of America's medical schools having CTSAs and even academic medical centers without CTSA funding creating “Centers for Translational Medicine” or “Clinical and Translational Science Institutes; and (4) translational medicine became a required component of the curriculum of U.S. medical schools. LCME Standard 7.3 (Scientific Method/Clinical/Translational Research) of the Liaison Committee on Medical Education, states: “The faculty of a medical school ensure that the medical curriculum includes instruction in the scientific method (including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena) and in the basic scientific and ethical principles of clinical and translational research. Thus, the concept of translational medicine has become inculcated into the psyche of American medical research and medical education. In fact, a Pubmed search using the key words “translational medicine” yields nearly 50,000 citations. But a new terminology has now entered medical research in the U.S—“Precision Medicine.” Unlike nomenclature that was introduced by leading physician-scientists, precision medicine was introduced to the public by President Obama in his State of the Union Address, January 20, 2015 when he announced that: “Tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes—and to give all of us access to the personalized information we need to keep ourselves and our families healthier.”6 In the press briefing that accompanied the announcement, the President posited that: “Most medical treatments have been designed for the ‘average patient.’ As a result of this ‘one-size-fits-all-approach,’ treatments can be very successful for some patients but not for others. This is changing with the emergence of precision medicine, an innovative approach to disease prevention and treatment that takes into account individual differences in people's genes, environments, and lifestyles. Precision medicine gives clinicians tools to better understand the complex mechanisms underlying a patient's health, disease, or condition, and to better predict which treatments will be most effective.” According to The White House, precision medicine would leverage advances in informatics, computational biology and a coordinated national effort as well as the enrollment of a million or more volunteers to develop new and more precise treatment strategies. Will “Precision Medicine” become an icon of American medicine or will it be this year's Edsel? I would argue that it should not be added to the medical lexicon for the following reasons. First, the term “precision medicine” implies that physicians do not currently provide patients with precise care. This is the wrong message to give the public and our students. We should be pointing out how research has already led us to be precise in our care: implanting a cardiac defibrillator in a patient with Brugada's syndrome, placing a coated stent after an angioplasty of a coronary lesion, or providing genetic counseling for a patient with a family history of breast and/or ovarian cancer and a BRCA1 or BRCA2 mutation. Second, the President has failed to address the bottlenecks that inhibit the delivery of “precise care” to a significant segment or our population when precise treatments are available: the high cost of many of the new targeted medications. Take for instance the new molecularly targeted drugs Imbruvica for mantle cell lymphoma, Lenyima for differentiated thyroid cancer or Zykadia for non–small cell lung cancer—all priced at nearly $140,000 per year. Third, the concept of gathering genetic, socioeconomic, ethnic, gender, activity and dietary data from a large cohort of voluntary subjects through smartphones and other high technology devices is intriguing and certainly has the potential for changing the way we look at disease—but there is no mention of the fact that underserved minorities have extremely low participation rates in clinical research and the elderly are challenged by devices. Therefore, great care must be taken to insure that we don't increase already existing disparities in healthcare. Fourth, the program fails to address the fact that big pharmaceutical companies have no interest in collecting genomic, proteomic or metabolomics data from large clinical trials because it is far more economical to show that a drug is effective in a large population of patients than to demonstrate that a drug is effective in only a defined subset of patients—and thus a small market. Finally, and most importantly, the President has committed an investment of only $215 million that will be shared across the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and the Office of the National Coordinator for Health Information Technology (ONC). In fact, only $70 million will be allocated to the National Cancer Institute to scale up efforts to identify genomic drivers in cancer and to apply that knowledge to the development of new approaches for the treatment of cancer. By contrast, commercial development of a single new drug or biologic costs nearly $1 billion. Thus, even an initiative that is focused only on cancer will have little chance of success when such a paltry sum is invested. In a recent perspective, Francis Collins and Harold Varmus supported the concept of Precision Medicine and opined that by taking advantage of research tools including proteomics, metabolomics, and genomics, smart phones and social media to collect data on patient outcomes and disease progression and computational biology and data analytics to collate and interpret large data sets we achieve a health care system in which we use “prevention and treatment strategies that take individual variability into account.”7 I certainly can't argue with their vision, but I would argue that what they are really describing is the translation of data acquired from the research bench, from individual patients, or from large data sets to the development of new diagnostics and treatment strategies for both individuals and populations—an area that for over a decade we have referred to as “Translational Medicine.” The term translational medicine is widely accepted, clearly defined and substantial financial supported has been directed towards translational medicine programs by the NIH and from private sources. In fact, translational scientists spend each day trying to make the care of patients more precise. Therefore, it would serve science and education best if we retained clinical and translational science as what we do and respectfully suggest to the President that he focus his efforts on significantly increasing the NIH budget and not on labeling fields of research efforts.

Non-invasive biomarkers offer potential to improve risk stratification and early diagnosis of lung cancer, complementing low-dose computed tomography (LDCT) screening. This study employed bibliometric analysis to identify global research trends, collaborative networks, and future directions in lung cancer biomarker research. Publications on lung cancer biomarkers for screening were retrieved from the Web of Science Core Collection (WoSCC). Data processing and visualisation were performed using Citespace, VOSviewer, KH Coder, Latent Dirichlet Allocation (LDA) topic modelling, and the online bibliometric analysis platform. Burst detection analysis was performed to predict emerging research trends. Analysis of 3636 publications revealed exponential growth in research output since 2014. International collaboration demonstrated a dual-core structure centred on China and the United States, with Chinese institutions showing high publication volumes and American institutions demonstrating greater citation influence. Journal citation mapping revealed three evolutionary phases: basic mechanisms-clinical translation-intelligent integration. LDA topic modelling identified 22 topics grouped into five core research directions: imaging and pathological diagnostic techniques; molecular and omics marker research; liquid biopsy and new detection technologies; clinical and translational medicine research; and tumour biology and treatment mechanisms. Burst detection analysis predicted future four priority areas: epigenetic studies centred on DNA methylation for risk prediction; treatment resistance and invasion mechanisms; liquid biopsy technology development; and targeted therapy clinical trials. Lung cancer biomarker research has evolved towards multimodal, intelligent screening approaches. Future research priorities include DNA methylation-based markers, circulating microRNA signatures, and artificial intelligence-assisted diagnostic platforms to improve early detection accuracy and complement LDCT screening.

As a serious iatrogenic complication, the incidence and clinical importance of contrast-induced nephropathy (CIN) have become increasingly prominent. CIN not only increases the length of hospital stay, medical cost and short-term mortality, but also is an independent predictor of long-term renal function deterioration and adverse cardiovascular events. At present, there is no effective method to completely avoid the occurrence of CIN after the use of contrast media in clinical practice, and the treatment of CIN that has occurred is also limited. Therefore, the prevention of CIN has become the focus of clinical research, and the identification of the risk factors of CIN is the basis and key link in the development of prevention programs. The purpose of this study is to review the existing evidence and further study the pathogenesis, risk factors and early predictors of CIN, so as to provide a reference for medical staff to formulate preventive measures, thereby reducing the risk of CIN and improving medical quality and ensuring patient safety.

The aim of this study was to systematically evaluate the antimicrobial potential of Compound Huangbai Liquid (HB) against Staphylococcus aureus (S. aureus), Escherichia coli (E. coli) and methicillin-resistant Staphylococcus aureus (MRSA) infections. A multidimensional research strategy combining clinical trials, bacteriological experiments and animal model studies was used. The clinical efficacy and adverse effects of HB were observed in patients with abdominal abscesses and non-lactating breast abscesses. The antimicrobial activity of HB was assessed in vitro by minimal inhibitory concentration (MIC), and its antibacterial, anti-inflammatory as well as pro-healing mechanisms were explored in a mouse infection model. Clinical studies of abdominal abscesses showed that patients in the HB treatment group had a significantly lower rate of pus bacterial positivity, lower serum white blood cell (WBC), neutrophil (NEU) and C-reactive protein (CRP) levels, higher levels of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and basic fibroblast growth factor (βFGF), reduced pus volume and shorter hospitalization time. Clinical studies of non-lactating breast abscesses showed that HB significantly reduced tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels, promoted wound healing and relieved pain. No significant adverse effects were observed in either clinical study, and there was no statistically significant difference in the recurrence rate during long-term follow-up, indicating that HB has a favorable safety profile and stable efficacy. The results of bacteriological experiments showed that the MICs of HB on S. aureus and E. coli were 140 µg/mL and 500 µg/mL, respectively, showing concentration-dependent bacteriostatic effects. Animal experiments further revealed that HB significantly reduced the wound bacterial load, inhibited inflammatory cell infiltration, increased the number of fibroblasts, and down-regulated the levels of inflammatory factors such as IL-1, IL-6, and TNF-α, while up-regulating the expression of tissue repair factors such as EGF, VEGF-A, and TGF-β. HB possesses antimicrobial effects against S. aureus and E. coli and possesses the prospect of further development as an antimicrobial adjuvant therapeutic agent.

Emergency tracheal intubation is a high-risk, life-support procedure that requires rapid and safe sedation. This study aimed to evaluate the clinical effectiveness and safety of remimazolam tosilate compared to propofol for sedation during emergency resuscitation intubation. This retrospective cohort study included adult patients who underwent sedation-assisted emergency intubation between June 2022 and June 2025. Patients were grouped according to the primary sedative administered: propofol or remimazolam. Sedation depth was assessed using the Ramsay score, and intubation success rates were recorded. Hemodynamic indices and respiratory rates were documented pre- and post-intubation. The incidence of adverse events and cognitive function at postoperative 72 hours were also evaluated. A total of 216 patients were included (104 in the propofol group and 112 in the remimazolam group). Propofol demonstrated a faster onset of sedation (42.12 &#xb1; 6.63 vs. 95.12 &#xb1; 10.17 seconds, P < 0.001), whereas remimazolam achieved a significantly higher first-attempt intubation success rate (87.50% vs. 66.35%, P < 0.001). After intubation, patients in the remimazolam group maintained higher systolic blood pressure (122.20 &#xb1; 9.77 vs. 116.42 &#xb1; 17.38 mmHg, P=0.003) and mean arterial pressure, as well as a lower rate-pressure product (10395.81 &#xb1; 928.89 vs. 10754.15 &#xb1; 1168.58 mmHg/min, P=0.014). The remimazolam group also exhibited lower incidences of hypotension (9.82% vs. 20.19%, P=0.032) and respiratory depression (5.36% vs. 17.31%, P=0.005), and experienced less injection pain (5.36% vs. 27.88%, P < 0.001). In emergency intubation, compared to propofol, remimazolam tosilate demonstrated a slower onset of sedation but offers better hemodynamic stability, higher first-attempt success rates, more favorable respiratory profiles, and improved early cognitive recovery, making it a valuable alternative sedative.

To evaluate the effects of esmolol plus carvedilol in treating myocardial ischemia in coronary heart disease (CHD), with a focus on blood pressure (BP), heart rate (HR), and safety. A total of 120 patients with CHD-related myocardial ischemia admitted to our hospital between January 2022 and January 2023 were enrolled. Among them, 60 patients were treated with carvedilol monotherapy (control group), and the other 60 cases received esmolol in combination with carvedilol (research group). Therapeutic efficacy, BP, HR, premature beat counts, dynamic electrocardiogram parameters (duration and frequency of ST-segment depression), cardiac function indicators (left ventricular end-diastolic dimension [LVEDD], left ventricular posterior wall thickness [LVPWT], left ventricular septal thickness [LVST], left ventricular ejection fraction [LVEF]), and biochemical indicators (N-terminal pro-B-type natriuretic peptide [NT-proBNP], superoxide dismutase [SOD]) were assessed. Safety profiles, including nausea and vomiting, hypotension, and drowsiness, were recorded. Furthermore, factors influencing therapeutic efficacy were analyzed. Compared with the control group, patients in the research group exhibited significantly lower BP (systolic: (105.27&#xb1;7.72) mmHg vs. (113.78&#xb1;11.46) mmHg; diastolic: (64.98&#xb1;4.81) mmHg vs. (71.35&#xb1;7.76) mmHg and HR (67.90&#xb1;5.63) bpm vs. (85.67&#xb1;7.35) bpm). In addition, post-treatment premature beat counts (premature ventricular contraction count: (71.15&#xb1;26.02) times/24 h vs. (253.67&#xb1;78.62) times/24 h; premature atrial contraction count: (105.35&#xb1;41.38) times/24 h vs. (279.53&#xb1;59.30) times/24 h; junctional premature contraction count: (73.85&#xb1;30.65) times/24 h vs. (153.58&#xb1;40.07) times/24 h) were notably reduced in the research group. The duration ((22.90&#xb1;3.43) min vs. (54.50&#xb1;4.34) min) and frequency ((7.25&#xb1;1.97) times vs. (12.47&#xb1;3.33) times), of ST-segment depression were significantly decreased in the research group. Moreover, LVEDD ((42.05&#xb1;4.21) mm vs. (46.48&#xb1;3.98) mm), LVPWT ((9.23&#xb1;2.25) mm vs. (11.18&#xb1;2.59) mm), LVST ((8.72&#xb1;2.48) mm vs. (10.30&#xb1;2.71) mm), and NT-proBNP ((310.63&#xb1;32.83) pg/mL vs. (403.87&#xb1;40.51) pg/mL) were significantly reduced in the research group, whereas LVEF ((59.63&#xb1;6.77)% vs. (53.73&#xb1;5.04)%) and SOD ((112.72&#xb1;10.12) U/mL vs. (90.60&#xb1;9.85) U/mL) were significantly increased. The overall incidence of adverse events was lower in the research group. Multivariate analysis identified HR (OR=4.592, 95% CI: 1.289-16.366, P=0.019), LVEF (OR=0.290, 95% CI: 0.086-0.976, P=0.046), and NT-proBNP (OR=3.729, 95% CI: 1.124-12.371, P=0.031) as independent factors influencing therapeutic efficacy. Esmolol combined with carvedilol demonstrates superior efficacy and safety compared with carvedilol monotherapy in patients with myocardial ischemia secondary to CHD.

Intraoperative neurophysiological monitoring (IONM) plays a critical role in spinal surgery by reducing the risk of nerve injury; however, its quality can be significantly influenced by anesthetic agents. This study aimed to compare the effects of remimazolam and propofol on IONM performance and postoperative recovery. This retrospective analysis included patients who underwent prone-position spinal surgery with IONM between January 2021 and June 2025. Patients were divided into either a remimazolam group or a propofol group according to the primary sedative administered. The outcomes assessed included IONM parameters [somatosensory evoked potentials (SEP)/motor evoked potentials (MEP) amplitude/latency] after intubation (T1) and at 30 min (T3) and 50 min (T4) following recovery from neuromuscular blockade. Additional outcomes included hemodynamics, remifentanil consumption, recovery time, and cognitive function scores. A total of 204 patients included in the analysis (Remimazolam group: 101 cases, Propofol group: 103 cases). Compared to the propofol group, the remimazolam group demonstrated significantly improved IONM signals, higher SEP amplitude at T4 (2.16 vs. 1.97 &#x3bc;V, P<0.001), and higher MEP amplitude at T4 (1680.73 vs. 1500.64 &#x3bc;V, P<0.001). The incidence of hypotension (6.93% vs. 19.42%, P=0.009) and bradycardia (5.94% vs. 14.56%, P=0.043) were significantly lower, while remifentanil consumption was significantly higher (2005.64 vs. 1425.44 ug, P<0.001) in the remimazolam group. In addition, patients in the remimazolam group exhibited shorter recovery times (awakening time: 18.91 vs. 24.25 min, P<0.001) and better cognitive function (MoCA score on postoperative Day 3: 24.41 vs. 23.54, P<0.001). Remimazolam provides superior IONM conditions, a lower incidence of intraoperative hypotension and bradycardia, and faster postoperative recovery compared to propofol in patients undergoing spinal surgery.

To investigate the effect of remazolam combined with hydromorphone on postoperative cognitive function in elderly patients undergoing hip replacement. 184 elderly patients who underwent hip replacement in Sir Run Run Shaw hospital from January 2023 to January 2025 were retrospectively analyzed. According to the intraoperative anesthesia scheme, they were divided into an observation group (remazolam combined with postoperative hydromorphone analgesia) and a control group (propofol combined with postoperative hydromorphone analgesia). The intraoperative hemodynamics, anesthesia recovery, incidence of cognitive dysfunction (POD) within 7 days after operation, scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA), visual analogue scale (VAS) score within 48 hours after operation, hydromorphone dosage, joint function score, adverse reactions, and analgesia satisfaction were compared between the two groups. There was no significant difference in intraoperative hemodynamic indexes or post-anesthesia monitoring treatment room stay time between the two groups (P > 0.05), but the eye opening time and extubation time in the observation group were shorter (P < 0.05) and the incidence of POD in the observation group were lower than in the control group within 7 days after operation. The scores of MoCA and MMSE in the observation group were higher than those in the control group on the 1st and 3rd day after operation (P < 0.05), but there was no difference between the two groups on the 7th day after operation. There was no significant difference in VAS scores between the two groups at each time point after operation, but the cumulative dosage of hydromorphone in the observation group was higher at 6 hours and 24 hours after operation (P < 0.05), and there was no difference between the two groups at 48 hours. The analgesic satisfaction of the observation group was higher (P < 0.05). There was no significant difference in the incidence of adverse reactions or joint function scores between the two groups. Remazolam combined with hydromorphone for postoperative analgesia in elderly patients undergoing hip replacement can help reduce the incidence of early POD, promote anesthesia recovery, improve analgesia satisfaction, and does not increase adverse reactions.

To explore the value of q-Dixon magnetic resonance imaging (MRI) in assessing the severity of lumbar osteoporosis in patients with type 2 diabetes mellitus (T2DM). A retrospective analysis was conducted on 100 T2DM patients admitted to our hospital between 2023 and 2024, who were divided into a control group (n = 43), an osteopenia group (n = 26), and an osteoporosis group (n = 31). General data (including use of hypoglycemic agents and menopausal status) was collected. Bone mineral density (BMD) of L1-L4 was measured using dual-energy X-ray absorptiometry (DXA), and bone marrow fat fraction (FF) was measured using q-Dixon technology. Statistical analysis included ANOVA, correlation tests, receiver operating characteristic (ROC) curve analysis, and DeLong's test. Regarding lumbar BMD and FF, the osteoporosis group had lower L1-L4 and total lumbar BMD than the other groups, and the osteopenia group had lower BMD than the control group (all P<0.05); conversely, the osteoporosis group had higher L1-L4 and total lumbar FF than the other groups, and the osteopenia group had higher FF than the control group (all P<0.05). In each group, males had higher L1-L4 segmental and total BMD, as well as total FF than females (all P<0.05), except for L3 BMD in the control group and L1-L4 segmental FF in the control and osteopenia groups (all P>0.05). Significant segmental differences were detected in both BMD and FF across lumbar spine segments. BMD followed a descending order of L3 > L4 > L2 > L1, whereas FF was ordered as L4 > L3 > L2 > L1 (all P<0.05). Kendall correlation analysis showed that L1-L4 and total BMD were negatively correlated with osteoporosis (r = -0.587 to -0.790, all P<0.001); L1-L4 and total FF were positively correlated with osteoporosis (r = 0.387 to 0.506, all P<0.001). Pearson correlation analysis showed that L1-L4 and total FF were negatively correlated with L1-L4 and total BMD (all P<0.01), and the correlation was stronger in females than males. ROC curves showed AUC for assessing osteoporosis severity by total FF was 0.856 (sensitivity 77.42%, specificity 81.16%, Youden index 0.586). DeLong's test showed the AUC of total FF was significantly higher than that of L1 FF (0.734, P = 0.034), while there were no statistically significant differences in the AUCs of total FF compared with those of L2-L4 FF (0.821, 0.829, and 0.823, respectively) (all P>0.05). The q-Dixon technique can effectively assess the severity of lumbar osteoporosis in patients with T2DM. Total FF is a reasonable and reliable non-invasive indicator because it integrates L1-L4 segmental information, has the highest AUC, and exhibits segmental and gender differences, providing a novel clinical strategy.

Our study aims to assess the causal association between plasma proteins, immune cell phenotypes and intracerebral hemorrhage (ICH) and explore their downstream biological correlation. We adopted the two-sample Mendelian randomization (MR) approach. The analysis evaluated the effects of more than 4,000 plasma proteins and 731 immune cell phenotypes on the risk of ICH. Bidirectional MR, mediation effect and sensitivity analysis confirm the causal relationship. We transfect SH-SY5Y neuroblastoma cells and overexpress AHSP or ITGB5 to observe possible function effects. MR analysis linked 299 plasma proteins with ICH (P < 0.05), of which 60 proteins showed strong statistical support (P < 0.01) and there was no reverse causality. Eighteen types of immune cells also affect ICH risk. Mediation analysis identified 6 causal axes to link specific proteins (IGF1R, NT5E/CD73, ITGB5, CUZD1, and AHSP) with ICH, in which different B cell and T cell subgroups play a key intermediary role. Overexpression of AHSP or ITGB5 inhibits the proliferation and migration of SH-SY5Y cells while promoting their apoptosis. We combined genetics and laboratory data to find that several plasma proteins affect ICH risk. The immune pathway seems to link these proteins with ICH. Although we acknowledge the limitations of MR analysis and in vitro experimental frameworks, the apoptosis promoting effects of AHSP and ITGB5 provide preliminary functional evidence of their role in neuronal damage. Targeting these pathways may provide new strategies for intervention in ICH.