Выявление резервов производства методами статистического моделирования по пассивным данным

Предложенные методы позволяют использовать цеховую контрольно-измерительную информацию для получения модели конкретного технологического процесса (операции)

General practitioners' prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms:Mixed methods study

OBJECTIVES: To evaluate general practitioners’ (GPs’) prescribing behaviour as a determinant of persistence with and adherence to inhaled corticosteroids (ICS) in children. DESIGN: Prospective observational study of persistence with and adherence to ICS followed by a focus group study of the GPs prescribing this treatment. SETTING: 7 primary care practices in the area of Zwolle, the Netherlands. PARTICIPANTS: 134 children aged 2–12 years had been prescribed ICS in the year before the study started by their 19 GPs. MAIN OUTCOME MEASURES: Patterns and motives of GPs’ prescribing behaviour and the relationship with persistence with and adherence to ICS. RESULTS: GPs’ prescribing behaviour was characterised by prescribing short courses of ICS to children with various respiratory symptoms without follow-up for making a diagnosis of asthma. This was driven by the GPs’ pragmatic approach to deal with the large number of children with respiratory symptoms, and by beliefs about ICS which differed from currently available evidence. This prescribing behaviour was the main reason why 68 (51%) children did not persist with the use of ICS. In children with persistent use of ICS and a GP's advice to use ICS on a daily basis, the median (IQR) adherence was 70% (41–84%), and was similar for patients with persistent asthma and children lacking a diagnosis or symptoms of asthma. CONCLUSIONS: Inappropriate prescription of ICS to children by GPs is common and drives the lack of persistence with ICS therapy in primary care. This finding should be taken into account when interpreting data from large prescription database studies. Improving primary healthcare providers’ knowledge and competence in diagnosing and managing asthma in children is needed

Reactions to peanut at first introduction in infancy are associated with age ≥8 months and severity of eczema

Background: Previous studies have shown the efficacy of the early introduction of peanut to prevent peanut allergy. Due to the exclusion of infants with sensitization to peanut, it remains unclear what the optimal timing of introduction is. Methods: The PeanutNL study was performed in 6 pediatric allergology centers in the Netherlands. Infants referred for the clinical early introduction of peanut to prevent peanut allergy underwent skin prick tests for peanut and an oral peanut challenge at a median age of 6 months. Results: One hundred sixty two of 707 infants (23%) who had never eaten peanut before were sensitized to peanut, of which 80 (49%) had wheals of &gt;4 mm. Sixty seven of 707 infants (9.5%) had a positive oral challenge to peanut at first introduction. Multivariate analysis revealed that age (p &lt;.001) and SCORAD eczema severity scores (p =.001) were significant risk factors. Introduction of peanut at ≥8 months in infants with moderate and severe eczema resulted in an increased risk (odds ratio 5.24 (p =.013) and 3.61 (p =.019), respectively) of having reactions to peanut as compared to introduction before 8 months. A family history of peanut allergy and previous reactions to egg were not identified as independent risk factors. Conclusion: These results suggest that peanut should be introduced before the age of 8 months to reduce the risk of reactions at first exposure in infants with moderate and severe eczema. Furthermore, since children with severe eczema have the highest risk of reactions, the clinical introduction of peanut should be considered, at the latest at the age of 7 months.</p