从理想到现实世界实现的连续性的细微化:关于Nilsen等人对编辑的一封信
Ann Catrine Eldh1,2, Anna Bergström3,4,5, Maria Hälleberg-Nyman6,7
1Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. ann.catrine.eldh@liu.se.
Implementation science communications
|November 1, 2025
概括
尼尔森和其他人. 提出了实施研究的连续性,但这篇评论表明双轴模型更好. 这种方法考虑了干预和上下文的复杂性,以实现更现实的医疗保健质量改善.
科学领域:
- 实施科学 实施科学
- 改善医疗保健质量 改善医疗保健质量
- 医疗保健服务研究 医疗服务研究
背景情况:
- 尼尔森和其他人. 建议区分实施效率与使用单轴连续性的有效性.
- 这一框架旨在将实施研究从理想条件到现实条件的范围内进行.
- 作者承认这一概念进步在实施科学中的价值.
研究的目的:
- 对于实施研究,批判性地评估单轴连续性的局限性.
- 提出一个替代的概念模型,更好地适应医疗保健中的上下文复杂性.
- 倡导经济评估的细微方法和在实施科学中利益相关者的参与.
主要方法:
- 该评论批评了单轴连续模型,借鉴了在改善医疗保健质量的广泛经验.
- 它提出了一个修订后的概念框架:一个双轴模型,考虑实施干预及其背景.
- 它建议将"实施PRECIS"工具与现有的评估方法和利益相关者联合生产相结合.
主要成果:
- 一个单轴连续性可能会过分简化实施干预和现实环境之间的复杂相互作用.
- 实施干预措施经常混合了有效性和有效性的元素,挑战了整洁的分类.
- 双轴模型提供了更细致的实现科学的表现,承认了上下文的变化.
结论:
- 拟议的双轴模型为理解实施研究提供了一个更加务实和响应上下文的框架.
- 细微的经济评估和利益相关者的共同生产对于推进实施科学至关重要.
- 需要在不同的环境中进行进一步的经验验证,以完善和支持这些概念上的进步,以实现可持续的医疗保健改进.
相关概念视频
Ethers from Alkenes: Alcohol Addition and Alkoxymercuration-Demercuration
Overview
Ethers can also be prepared from alkenes through acid-catalyzed addition of alcohols and alkoxymercuration–demercuration.
Preparation of Ethers by Acid-Catalyzed Addition of Alcohol to Alkenes
The acid-catalyzed addition of alcohol to an alkene involves treating the alkene with an excess of alcohol in the presence of an acid catalyst to form an ether under suitable conditions. The hydrogen will add to the less substituted carbon so that the nucleophile can attack the more substituted...
Ethers can also be prepared from alkenes through acid-catalyzed addition of alcohols and alkoxymercuration–demercuration.
Preparation of Ethers by Acid-Catalyzed Addition of Alcohol to Alkenes
The acid-catalyzed addition of alcohol to an alkene involves treating the alkene with an excess of alcohol in the presence of an acid catalyst to form an ether under suitable conditions. The hydrogen will add to the less substituted carbon so that the nucleophile can attack the more substituted...
Isomerism in Alkenes
Alkenes like 1-butene and 2-butene exhibit constitutional isomerism, as they differ in the position of the double bond. Further, 2-butene exhibits stereoisomerism and exists as two distinct compounds differing in spatial arrangement.
An isomer is called cis-2-butene when the methyl groups are on the same side of the double bond, and the other stereoisomer, in which methyl groups are on the opposite side of the double bond, is called trans-2-butene. The cis and trans stereoisomers are not...
An isomer is called cis-2-butene when the methyl groups are on the same side of the double bond, and the other stereoisomer, in which methyl groups are on the opposite side of the double bond, is called trans-2-butene. The cis and trans stereoisomers are not...
Reduction of Alkynes to trans-Alkenes: Sodium in Liquid Ammonia
Alkynes can be reduced to trans-alkenes using sodium or lithium in liquid ammonia. The reaction, known as dissolving metal reduction, proceeds with an anti addition of hydrogen across the carbon–carbon triple bond to form the trans product. Since ammonia exists as a gas (bp = −33°C) at room temperature, the reaction is carried out at low temperatures using a mixture of dry ice (sublimes at −78°C) and acetone.
When dissolved in liquid ammonia, an alkali metal, such as sodium, dissociates into a...
When dissolved in liquid ammonia, an alkali metal, such as sodium, dissociates into a...
Limitations of Friedel–Crafts Reactions
Several restrictions limit the use of Friedel–Crafts reactions. First, the halogen in the alkyl halide must be attached to an sp3-hybridized carbon for the Friedel–Crafts reactions to occur. Vinyl or aryl halides do not react since the carbocations formed are unstable under the reaction conditions. Second, Friedel–Crafts alkylation is susceptible to carbocation rearrangement, and the major products obtained have a rearranged carbon skeleton. In contrast, the acylium ion is stabilized by...
Enolate Mechanism Conventions
When a carbonyl compound is treated with a strong base, the α position gets deprotonated to give a resonance-stabilized intermediate called an enolate. Enolates are ambident nucleophiles because they possess two nucleophilic sites that can attack an electrophile owing to the delocalization of the negative charge between the α carbon and oxygen atoms. When the oxygen atom attacks an electrophile, it is called O-attack, whereas electrophilic attack via the α carbon is known as C-attack.
C-attack...
C-attack...
Stereochemical Effects of Enolization
The chiral α-carbon of the carbonyl compound is the stereocenter of the molecule. As shown in the figure below, when such a carbonyl compound undergoes racemization under an acidic or basic condition, an achiral enol is formed.
