386 research outputs found
When complexity matters: a step-by-step guide to incorporating a complexity perspective in guideline development for public health and health system interventions
Background
Guidelines on public health and health system interventions often involve considerations beyond effectiveness and safety to account for the impact that these interventions have on the wider systems in which they are implemented. This paper describes how a complexity perspective may be adopted in guideline development to facilitate a more nuanced consideration of a range of factors pertinent to decisions regarding public health and health system interventions. These factors include acceptability and feasibility, and societal, economic, and equity and equality implications of interventions.
Main message
A 5-step process describes how to incorporate a complexity perspective in guideline development with examples to illustrate each step. The steps include: (i) guideline scoping, (ii) formulating questions, (iii) retrieving and synthesising evidence, (iv) assessing the evidence, and (v) developing recommendations. Guideline scoping using stakeholder consultations, complexity features, evidence mapping, logic modelling, and explicit decision criteria is emphasised as a key step that informs all subsequent steps.
Conclusions
Through explicit consideration of a range of factors and enhanced understanding of the specific circumstances in which interventions work, a complexity perspective can yield guidelines with better informed recommendations and facilitate local adaptation and implementation. Further work will need to look into the methods of collecting and assessing different types of evidence beyond effectiveness and develop procedural guidance for prioritising across a range of decision criteria
PROVISIONAL RESTORATIONS IN RESTORATIVE DENTISTRY
Provisional restorations are of a great significance in fixed prosthodontic rehabilitation, particularly in case long-term treatment is needed before final prosthetics. The restorations are also important from the point of view of diagnosis and treatment plan assessment so they should be similar to the final constructions in their shape and function. Provisional restorations quite often need alterations and adjustment to the new requirements, so itβs important to comprehend the compositional properties of the base and repair materials to make a reliable bond between them. Thus, interim treatment should meet a number of requirements such as biocompatibility, marginal adaptation, strength and longevity. The purpose of this review is to discuss fabrication technology of provisional restorations, possible failure and complications, the ways to correct them as well as the aspects of relining provisional restoration.Provisional restorations are of a great significance in fixed prosthodontic rehabilitation, particularly in case long-term treatment is needed before final prosthetics. The restorations are also important from the point of view of diagnosis and treatment plan assessment so they should be similar to the final constructions in their shape and function. Provisional restorations quite often need alterations and adjustment to the new requirements, so itβs important to comprehend the compositional properties of the base and repair materials to make a reliable bond between them. Thus, interim treatment should meet a number of requirements such as biocompatibility, marginal adaptation, strength and longevity. The purpose of this review is to discuss fabrication technology of provisional restorations, possible failure and complications, the ways to correct them as well as the aspects of relining provisional restoration
Optical transition radiation in fused quartz under external acoustic field
In the present paper we have investigated the optical transition radiation in a plate excited by a longitudinal acoustic wave. The spectral-angular density of the radiated energy is calculated. The numerical examples are given for
a plate of fused quartz. These results show that the acoustic waves allow to control the parameters of the radiation. In particular, new resonance peaks appear in the
spectral distribution of the radiation intensity. The height of the peaks can be tuned by choosing the parameters of the acoustic wave
ΠΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅ ΠΎΡΡΠΎΠΊΠ° ΠΆΠ΅Π»ΡΠΈ ΠΏΡΠΈ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΈ Π³Π΅ΠΏΠ°ΡΠΈΠΊΠΎΡ ΠΎΠ»Π΅Π΄ΠΎΡ Π° ΠΈ Π½Π΅ΡΠΎΡΡΠΎΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π±ΠΈΠ»ΠΈΠΎΠ±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° ΠΏΠΎΡΠ»Π΅ Π»Π°ΠΏΠ°ΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ ΠΎΠ»Π΅ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΠΈ
The aspect of injuring bile ducts during laparoscopic cholecystectomy is still of current concern. Causes of this complication include insufficient experience of surgical team, poor knowledge of topographic anatomy of subhepatic space, particularly when perivesical inflammatory infiltrate presents, inadequate approach conversion and so on. Most of patients with bile duct injuries undergo repeated operation in the same surgical unit where cholecystectomy was performed. In many cases, this results in a shortening of the segment of the common hepatic duct, which is favorable for restoration. Subsequent reconstructive surgery is usually performed in the worse conditions with a high risk of complications such as failure of sutures, biliary fistula, anastomotic stricture, etc. Most specialists recommend to abstain from primary reconstruction of the biliary tree in hospitals with no proper experience in hepatobiliary surgery and to perform only the external drainage of subhepatic space with subsequent admission of patient to a specialized clinic. We report a case of a young woman who suffered an excision of hepaticocholedochus fragment during laparoscopic cholecystectomy. A primary reconstructive surgery (hepatico-hepaticoanastomosis) was performed in the same clinic and resulted in external fistula of the common hepatic duct. The subsequent operation (hepaticoejunostomy) was performed in a specialized department of the regional clinical hospital. The woman underwent right-sided hypochondrium laparotomy with debridement of postoperative scar tissues. The stumps of common bile duct were mobilized in compact inflammatory infiltrate. The operation ended with distal stump closure and hepaticoenteroanastomosis formation. The patient was discharged with recovery. Six months later, her condition was satisfactory, and she was engaged in occupational activity.ΠΡΠΎΠ±Π»Π΅ΠΌΠ° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠΎΡΠΎΠΊΠΎΠ² Π²ΠΎ Π²ΡΠ΅ΠΌΡ Π»Π°ΠΏΠ°ΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΠΈ Π½Π΅ ΡΠ΅ΡΡΠ΅Ρ ΡΠ²ΠΎΡ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΡΠΈΡΠΈΠ½Ρ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ: Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΡΠΉ ΠΎΠΏΡΡ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΡΠΈΠ³Π°Π΄Ρ, ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Π½ΡΠ΅ Π·Π½Π°Π½ΠΈΡ ΡΠΎΠΏΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°Π½Π°ΡΠΎΠΌΠΈΠΈ ΠΏΠΎΠ΄ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π°, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΏΠ΅ΡΠΈΠ²Π΅Π·ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠ°, Π½Π΅ΡΠ²ΠΎΠ΅Π²ΡΠ΅ΠΌΠ΅Π½Π½Π°Ρ ΠΊΠΎΠ½Π²Π΅ΡΡΠΈΡ Π΄ΠΎΡΡΡΠΏΠ° ΠΈ ΠΏΡΠΎΡΠ΅Π΅.ΠΠΎΠ»ΡΡΡΡ ΡΠ°ΡΡΡ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΡΡΠ°Π²ΠΌΠΎΠΉ ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠΎΡΠΎΠΊΠΎΠ² ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎ ΠΎΠΏΠ΅ΡΠΈΡΡΡΡ Π² Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡΡ
, Π³Π΄Π΅ Π²ΡΠΏΠΎΠ»Π½ΡΡΡ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΡ. ΠΠ΅ΡΠ΅Π΄ΠΊΠΎ ΡΡΠΎ Π·Π°ΠΊΠ°Π½ΡΠΈΠ²Π°Π΅ΡΡΡ Π½Π΅ΡΠΎΡΡΠΎΡΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ Π±ΠΈΠ»ΠΈΠΎΠ±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° ΠΈ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠΊΠΎΡΠΎΡΠ΅Π½ΠΈΡ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π΄Π»Ρ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ° ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ°.ΠΠΎΡΠ»Π΅Π΄ΡΡΡΡΡ ΡΠ΅ΠΊΠΎΠ½ΡΡΡΡΠΊΡΠΈΠ²Π½ΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ Π²ΡΠΏΠΎΠ»Π½ΡΡΡ Π² Ρ
ΡΠ΄ΡΠΈΡ
ΡΡΠ»ΠΎΠ²ΠΈΡΡ
Ρ Π²ΡΡΠΎΠΊΠΎΠΉ Π²Π΅ΡΠΎΡΡΒΠ½ΠΎΡΡΡΡ ΡΠ°Π·Π»ΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠΎΠ΄Π° ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ (Π½Π΅ΡΠΎΡΡΠΎΡΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΡΠ²ΠΎΠ², ΠΆΠ΅Π»ΡΠ½ΡΠΉ ΡΠ²ΠΈΡ, ΡΡΡΠΈΠΊΡΡΡΠ° Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° ΠΈ ΠΏΡΠΎΡΠ΅Π΅). ΠΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²ΠΎ Π°Π²ΡΠΎΡΠΎΠ² ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΡΡ Π²ΠΎΠ·Π΄Π΅ΡΠΆΠ°ΡΡΡΡ ΠΎΡ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΡ
ΡΠ΅ΠΊΠΎΠ½ΡΡΡΡΠΊΡΠΈΠΉ Π±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΠ΅Π²Π° Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ°Ρ
Π±Π΅Π· Π΄ΠΎΠ»ΠΆΠ½ΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ° Π³Π΅ΠΏΠ°ΡΠΎΠ±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ ΠΈ ΠΎΠ³ΡΠ°Π½ΠΈΡΠΈΡΡΡΡ ΡΠ°Π½Π°ΡΠΈΠ΅ΠΉ ΠΈ Π½Π°ΡΡΠΆΠ½ΡΠΌ Π΄ΡΠ΅Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΠΎΠ΄ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π° Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΈ. ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΌΠΎΠ»ΠΎΠ΄ΠΎΠΉ ΠΆΠ΅Π½ΡΠΈΠ½Ρ, ΠΊΠΎΡΠΎΡΠΎΠΉ Π²ΠΎ Π²ΡΠ΅ΠΌΡ Π»Π°ΠΏΠ°ΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΠΈ ΠΈΡΡΠ΅ΡΠ΅Π½ ΡΡΠ°Π³ΠΌΠ΅Π½Ρ Π³Π΅ΠΏΠ°ΡΠΈΠΊΠΎΡ
ΠΎΠ»Π΅Π΄ΠΎΡ
Π°.Π ΡΡΠΎΠΉ ΠΆΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° ΠΏΠ΅ΡΠ²ΠΈΡΠ½Π°Ρ ΡΠ΅ΠΊΠΎΠ½ΡΡΡΡΠΊΡΠΈΠ²Π½Π°Ρ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ (Π³Π΅ΠΏΠ°ΡΠΈΠΊΠΎΠ³Π΅ΠΏΠ°ΡΠΈΠΊΠΎΠ°Π½Π°ΡΡΠΎΠΌΠΎΠ·), ΠΏΠΎΡΠ»Π΅ ΠΊΠΎΡΠΎΡΠΎΠΉ ΡΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π»ΡΡ Π½Π°ΡΡΠΆΠ½ΡΠΉ ΡΠ²ΠΈΡ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ°. ΠΡΠ΅ΡΠ΅Π΄Π½Π°Ρ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΌ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΠΎΠ±Π»Π°ΡΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ. ΠΡΠΏΠΎΠ»Π½Π΅Π½Π° ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΏΡΠ°Π²ΠΎΡΡΠΎΡΠΎΠ½Π½ΡΡ ΠΏΠΎΠ΄ΡΠ΅Π±Π΅ΡΠ½Π°Ρ Π»Π°ΠΏΠ°ΡΠΎΡΠΎΠΌΠΈΡ Ρ ΠΈΡΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎΡΠ»Π΅ΒΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΡΠ±ΡΠ°. Π ΠΏΠ»ΠΎΡΠ½ΠΎΠΌ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌ ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠ΅ Ρ Π½Π°ΠΏΠ»Π°ΡΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠΈΠ±ΡΠΈΠ½Π° ΠΌΠΎΠ±ΠΈΠ»ΠΈΠ·ΠΎΠ²Π°Π½Ρ ΠΊΡΠ»ΡΡΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ°. ΠΠΈΡΡΠ°Π»ΡΠ½Π°Ρ ΠΊΡΠ»ΡΡΡ ΡΡΠΈΡΠ°. Π‘ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ Π³Π΅ΠΏΠ°ΡΠΈΠΊΠΎΡΠ½ΡΠ΅ΡΠΎΠ°Π½Π°ΡΡΠΎΠΌΠΎΠ·. ΠΠ°ΡΠΈΠ΅Π½ΡΠΊΠ° Π²ΡΠΏΠΈΡΠ°Π½Π° Ρ Π²ΡΠ·Π΄ΠΎΡΠΎΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ. ΠΡΠΈ ΠΎΡΠΌΠΎΡΡΠ΅ ΡΠ΅ΡΠ΅Π· 6 ΠΌΠ΅ΡΡΡΠ΅Π² ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅, ΡΠ°Π±ΠΎΡΠ°Π΅Ρ ΠΏΠΎ ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΡΡΠΈ
Lessons learnt: Undertaking rapid reviews on public health and social measures during a global pandemic
Public health and social measures (PHSM) have been central to the COVIDβ19 response. Consequently, there has been much pressure on decisionβmakers to make evidenceβinformed decisions and on researchers to synthesize the evidence regarding these measures. This article describes our experiences, responses and lessons learnt regarding key challenges when planning and conducting rapid reviews of PHSM during the COVIDβ19 pandemic. Stakeholder consultations and scoping reviews to obtain an overview of the evidence inform the scope of reviews that are policyβrelevant and feasible. Multiple complementary reviews serve to examine the benefits and harms of PHSM across different populations and contexts. Conceiving reviews of effectiveness as adaptable living reviews helps to respond to evolving evidence needs and an expanding evidence base. An appropriately skilled review team and good planning, coordination and communication ensures smooth and rigorous processes and efficient use of resources. Scientific rigor, the practical implications of PHSMβrelated complexity and likely time savings should be carefully weighed in deciding on methodological shortcuts. Making the best possible use of modeling studies represents a particular challenge, and methods should be carefully chosen, piloted and implemented. Our experience raises questions regarding the nature of rapid reviews and regarding how different types of evidence should be considered in making decisions about PHSM during a global pandemic. We highlight the need for readily available protocols for conducting studies on the effectiveness, unintended consequences and implementation of PHSM in a timely manner, as well as the need for rapid review standards tailored to βrapidβ versus βemergencyβ mode reviewing
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