纸塑包装无菌物品在临床的应用

目的 评价纸塑包装方法在临床应用的效果.方法 用纸塑包装和无纺布包装替换传统布类包装和摒弃贮槽.结果 纸塑包装在临床中使用方便,实用,省时省力,既延长无菌有效期,又可节省资源、成本和耗材明显下降.结论 纸塑包装临床使用效果较佳,值得大力推广.     

医用纸塑包装袋包装无菌物品在临床的应用与分析

目的 探讨用医用纸塑包装袋替代部分棉布类包装无菌物品。 方法 将体积较小的无菌物品用纸塑包装灭菌，研究灭菌效果及成本构成。 结果 纸塑包装的灭菌效果及保存时间优于棉布包装，纸塑包装成本降低14％。 结论 使用纸塑包装具有灭菌效果良好、延长不常用器械的使用受命、减轻医务人员劳动强度、降低成本等优点，值得推广和使用。     

医用纸塑密封包装代替布包装效果探讨

目的：探讨医用纸塑包装代替布包装的效果。方法：采用3M公司提供的纸塑包装，进行灭菌后效果观察。结果：该纸塑包装灭菌后的物品，其化学监测及细菌培养均合格。结论：纸塑包装对细菌具有超强阻抗力，存在时间长(半年至一年)，既经济，实惠，又减少物品浪费。     

棉布结合纸塑包装在无菌屏障系统中的应用

目的:探讨棉布结合纸塑包装的理化性能、阻菌效果、临床保存时限等,为灭菌物品的包装提供依据。方法:将试验集中包分为棉布结合纸塑管带包装组、纸塑管带包装组,对两组进行包装后的闭合性、灭菌后形态、灭菌因子穿透性、微生物屏障试验、无菌有效期鉴定等多项观察试验比较。结果:棉布结合纸塑管带包装与纸塑管带包装在包装后的闭合性、灭菌后形态、灭菌因子穿透性、包装有效期等的差异无统计学意义(P>0.05)。但是在微生物屏障试验中由于纸塑管带包装易被刺破、易湿包等原因,微生物屏障效果差于棉布结合纸塑管带包装,差异有统计学意义(P<0.05)。结论:棉布结合纸塑管带包装继承了各自的优点,在包装材料的组合上又是一项新的突破。既具有棉布良好的柔软性、穿透力、强抗张力,又具有纸塑管带可密封性、阻菌效果好、有效期长等优点,可用于使用频率低或贵重物品的包装;避免了纸塑管带包装易被刺破的缺点,尤其适合尖锐器械和不规则器械的包装;同时避免了棉布包装无菌有效期短和棉布包装的反复洗涤、反复包装、反复灭菌的人力、物力消耗。     

医用纸塑包装袋包装无菌物品在临床中的应用与分析

目的:探讨用医用纸塑包装袋替代部分棉布类包装包装无菌物品的可行性。方法:将体积较小的无菌物品用纸塑包装灭菌,研究灭菌效果及成本构成。结果:纸塑包装的灭菌效果及保存时间优于棉布包装,纸塑包装成本比棉布包装降低14%。结论:使用纸塑包装具有灭菌效果良好、延长不常用器械的使用寿命、减轻医务人员劳动强度、降低成本等优点,值得推广和使用。     

纸塑包装袋存在的安全隐患及质量控制措施

纸塑包装袋适用于临床急救包、缝合包、各类穿刺包及手术室单件备用器械物品的独立包装灭菌,克服了传统包装材料无菌屏障作用差、灭菌有效期短的缺点。纸塑包装灭菌包有效期可达6个月,减少重复灭菌对器械物品的损耗,直接降低了因反复消毒灭菌所需人力物力成本,并能通过纸塑包装袋塑面直观地看清所需器械和物品,方便临床使用,且纸塑包装灭菌包无菌阻隔效果好。但在包装、灭菌及临床使用中,     

纸塑无菌物品包装材料的临床应用

医院消毒供应中心是医院无菌物品中心站，是向全院提供各种无菌器材、敷料和其他无菌物品的重要科室。为了加强消毒供应中心科学管理，确保医疗质量，为医院提供合理的无菌物品，以满足临床治疗和护理需要，中心供应室应根据临床使用特点，对传统的无菌物品包装材料做出改进方法，采用一次性纸塑灭菌包装材料。纸塑包装袋是由特殊材料制作而成，具有细菌屏障作用，包装的器械物品不但美观，可透视，而且灭菌后可保存至少半年以上。利用纸塑包装的优点，将临床上必备但使用频率很低的器械包进行纸塑包装。现介绍如下。     

纸塑包装袋在消毒供应中心和临床使用中的质量管理

目的探讨纸塑包装袋在消毒供应中心和临床使用过程中的质量管理方法。方法消毒供应中心从纸塑包装袋质量验收、规格选择、包装封口操作、灭菌装载、灭菌监测、灭菌后质量检查等环节加强管理。对临床科室储存环境、取放方式、使用前质量检查方法和开启方式环节进行规范和管理。结果采用纸塑包装袋包装无菌包10万余件,未见使用不当导致的不良事件发生。结论加强纸塑包装袋在消毒供应中心和临床使用过程的全程质量管理,可以确保无菌包的安全。     

三种纸塑袋包装物品环氧乙烷灭菌后有效期的观察

目的观察纸塑袋包装物品用环氧乙烷灭菌效果及其对保存期的影响。方法采用无菌检验和化学监测方法进行环氧乙烷灭菌后和保存期间无菌质量检测。结果经环氧乙烷灭菌后的纸塑包装袋内指示卡和袋外指示色块变色全部合格。灭菌处理的纸塑包装物品保存9个月后,3M纸塑包装袋检出一次细菌阳性;芬兰WIPAK纸塑包装袋出现1次阳性。大可纸塑包装袋保存6~10个月后检出4次阳性。结论环氧乙烷对纸塑包装物品可达到灭菌要求;但保存期限不同。     

纸塑非单包装手术器械包装载与包装方法的改进

目的观察采用塑面朝下、纸面朝上平放装载的纸塑包装的非单包装手术器械不同的包装方法对器械干燥效果的影响。方法选用4把骨刀与2把咬骨钳作为试验对象,将器械上下两层平放,用单层纯棉手术巾作对折式包装,包装时在两层器械之间再用一层反折棉布相隔,然后再平放于纸塑包装袋内,观察两种不同的装包方法器械的干燥效果。结果对折式包装好的器械包单层棉布面在塑面的装包方法较多层棉布面在塑面的装包方法器械干燥效果好(P0.01)。结论非单包装手术器械采用纸塑包装时,在器械与塑面或器械与器械上下两层之间用单层吸水棉布相隔的包装法及塑面朝下、纸面朝上平放装载法,可有效解决纸塑非单包装手术器械包侧放装载的湿包问题。     

High-temperature resistant water-soluble polymers derived from exotic amino acids

High-performance water-soluble polymers have a wide range of applications from engineering materials to biomedical plastics. However, existing materials are either natural polymers that lack high thermostability or rigid synthetic polymers. Therefore, we design an amino acid-derived building block, 4,4′-diamino-α-truxillate dianion (4ATA²⁻), that induces water solubility in high-performance polymers. Polyimides containing 4ATA²⁻ units are intrinsically water-soluble and are processed into films cast from an aqueous solution. The resulting polyimide films exhibit exceptional transparency and extremely high thermal stability. In addition, the films can be made insoluble in water by simple post-treatment using weak acid or multivalent metal ions such as calcium. The synthesized polyimide''s derived from bio-based resources are useful for yielding waterborne polymeric high-performance applications.

High-performance water-soluble polymers have a wide range of applications from engineering materials to biomedical plastics. This article discusses the synthesis of water-soluble polyimide from bio-based monomers.     

Poly(lactic acid) (PLA) and polyhydroxyalkanoates (PHAs), green alternatives to petroleum-based plastics: a review

In spite of the fact that petroleum-based plastics are convenient in terms of fulfilling the performance requirements of many applications, they contribute significantly to a number of ecological and environmental problems. Recently, the public awareness of the negative effects of petroleum-based plastics on the environment has increased. The present utilization of natural resources cannot be sustained forever. Furthermore, oil is often subjected to price fluctuations and will eventually be depleted. The increase in the level of carbon dioxide due to the combustion of fossil fuel is causing global warming. Concerns about preservation of natural resources and climate change are considered worldwide motivations for academic and industrial researchers to reduce the consumption and dependence on fossil fuel. Therefore, bio-based polymers are moving towards becoming the favorable option to be utilized in polymer manufacturing, food packaging, and medical applications. This paper represents an overview of the feasibility of both Poly Lactic Acid (PLA) and polyhydroxyalkanoates (PHAs) as alternative materials that can replace petroleum-based polymers in a wide range of industrial applications. Physical, thermal, rheological, and mechanical properties of both polymers as well as their permeability and migration properties have been reviewed. Moreover, PLA''s recyclability, sustainability, and environmental assessment have been also discussed. Finally, applications in which both polymers can replace petroleum-based plastics have been explored and provided.

The dwindling nature, high price of petroleum, concerns about climate change, as well as the ever-growing population are all urging the plastics industries to adapt sustainable natural biopolymers solutions such as PLA and PHAs.     

Recent developments in conducting polymers: applications for electrochemistry

Scientists have categorized conductive polymers as materials having strongly reversible redox behavior and uncommon combined features of plastics and metal. Because of their multifunctional characteristics, e.g., simplistic synthesis, acceptable environmental stability, beneficial optical, electronic, and mechanical features, researchers have largely considered them for diverse applications. Therefore, their capability of catalyzing several electrode reactions has been introduced as one of their significant features. A thin layer of the conducting polymer deposited on the substrate electrode surface can augment the electrode process kinetics of several solution species. Such electrocatalytic procedures with modified conducting polymer electrodes can create beneficial utilization in diverse fields of applied electrochemistry. This review article explores typical recent applications of conductive polymers (2016–2020) as active electrode materials for energy storage applications, electrochemical sensing, and conversion fields such as electrochemical supercapacitors, lithium-ion batteries, fuel cells, and solar cells.

Scientists have categorized conductive polymers as materials having strongly reversible redox behavior and uncommon combined features of plastics and metal.     

Comparison between self‐assembling peptide nanofiber scaffold (SAPNS) and fibrin sealant in neurosurgical hemostasis

RADA16‐I is a synthetic type I self‐assembling peptide nanofiber scaffold (SAPNS) which may serve as a novel biocompatible hemostatic agent. Its application in neurosurgical hemostasis, however, has not been explored. Although RADA16‐I is nontoxic and nonimmunogenic, its intrinsic acidity may potentially provoke inflammation in the surgically injured brain. We conducted an animal study to compare RADA16‐I with fibrin sealant, a commonly used agent, with the hypothesis that the former would be a comparable alternative. Using a standardized surgical brain injury model, 30 Sprague–Dawley rats were randomized into three treatment groups: RADA16‐I, fibrin sealant or gelatin sponge (control). Animals were sacrificed on day 3 and 42. Astrocytic and microglial infiltrations within the cerebral parenchyma adjacent to the operative site were significantly lower in the RADA16‐I and fibrin sealant groups than control. RADA16‐I did not cause more cellular inflammatory response despite its acidity when compared with fibrin sealant. Immunohistochemical studies showed infiltration by astrocytes and microglia into the fibrin sealant and RADA16‐I grafts, suggesting their potential uses as tissue scaffolds. RADA16‐I is a promising candidate for further translational and clinical studies that focus on its applications as a safe and effective hemostat, proregenerative nanofiber scaffold as well as drug and cell carrier.     

Designing clinical trials and experiments efficiently with the program package CADEMO

This paper suggests the use of the program package CADEMO when designing clinical trials. Using this package a number of frequently incorrect or inefficient applications of statistical methods can be avoided. For instance, by determining the sample size for statistical tests in advance, the type-II-risk is guaranteed to be taken into account and, foremost, only relevant effects are likely to become significant. Although this is also true for some other program packages, CADEMO in addition exclusively analyzes data by sequential testing, specifically by sequential triangular tests according to Schneider [Schneider, B. 1992. An interactive computer program for design and monitoring of sequential clinical trials. In Proceedings of the XVIth international biometric conference (pp. 237–250). Hamilton, New Zealand.]; which on average lead to a lower sample size. Moreover CADEMO serves to determine the sample size for a confidence estimation of an unknown parameter and for the so-called selection procedures, which should be applied instead of using multiple comparisons of means, if the true objective of a study is to select only the best of all possibilities. Finally, CADEMO serves to factually randomize subjects into any more-way designed experiment. For each of the indicated applications an example is given and the respective handling of CADEMO is illustrated.     

Results from a type two hybrid-effectiveness study to implement a preoperative anemia and iron deficiency screening,evaluation, and management pathway

Background

Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited. This study sought to measure the impact of a theoretically informed, bespoke change package on improving the uptake of a Preoperative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathway.

Study Design and Methods

Pre-post interventional study using a type two hybrid-effectiveness design evaluated implementation. Four hundred (400) patient medical record reviews provided the dataset (200 pre- and 200-post implementation). The primary outcome measure was compliance with the pathway. Secondary outcome measures (clinical outcomes) were anemia on day of surgery, exposure to a red blood cell (RBC) transfusion, and hospital length of stay. Validated surveys facilitated data collection of implementation measures. Propensity score-adjusted analyses determined the effect of the intervention on clinical outcomes, and a cost analysis determined the economic impact.

Results

For the primary outcome, compliance improved significantly post-implementation (Odds Ratio 10.6 [95% CI 4.4–25.5] p < .000). In secondary outcomes, adjusted analyses point estimates showed clinical outcomes were slightly improved for anemia on day of surgery (Odds Ratio 0.792 [95% CI 0.5–1.3] p = .32), RBC transfusion (Odds Ratio 0.86 [95% CI 0.41–1.78] p = .69) and hospital length of stay (Hazard Ratio 0.96 [95% CI 0.77–1.18] p = .67), although these were not statistically significant. Cost savings of $13,340 per patient were realized. Implementation outcomes were favorable for acceptability, appropriateness, and feasibility.

Conclusion

The change package significantly improved compliance. The absence of a statistically significant change in clinical outcomes may be because the study was powered to detect an improvement in compliance only. Further prospective studies with larger samples are needed. Cost savings of $13,340 per patient were achieved and the change package was viewed favorably.     

Dealing with the Archetypes Development Process for a Regional EHR System

Objectives

This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process.

Methods

This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process.

Results

The main steps of the archetype modelling process were identified and described, and 20 archetypes were created.Lessons learned:

• – The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;
• – The initial focus on the archetype structural organization aspects was important;
• – The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;
• – Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;
• – Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;
• – The use of worksheets facilitated the modelling process by health professionals;
• – It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team.

Conclusion

The archetypes (referencing terminology, domain tables and term lists) provided a favorable condition for the use of a controlled vocabulary between the central repository and the EMR systems and, probably, will increase the chances of preserving the semantics from the knowledge domain. Finally, the reference model from the ISO 13606 norm, along with the archetypes, proved sufficient to meet the specificities for the creation of an EHR system for basic healthcare in a Brazilian state.     

Normal reference intervals of prognostic nutritional index in healthy adults: A large multi‐center observational study from Western China

BackgroundIt has been widely reported that the prognostic nutritional index (PNI) played a pivotal role in nutritional assessment of surgical patients and tumor prognosis. In order to improve the accuracy of evaluation in Western China, we established reference intervals (RIs) of PNI in healthy controls.MethodsA retrospective cohort study on healthy ethnic Han adults (18–79 years) was conducted to explore the influences of age, gender, study centers, and instruments on PNI and to establish RIs. The data came from a healthy routine examination center database and laboratory information system (LIS) of four centers in Western China, and there were 200 persons selected randomly for verification of RIs.ResultsFive thousand eight hundred and thirty‐nine healthy candidates were enrolled. PNI showed a marked gender dependence, and males had significantly higher PNI than females across all ages (p < 0.01). We found that PNI is significantly different between age groups (p < 0.01), the value of PNI tended to decrease with age increasing. There is also an obvious influence of centers and instruments on PNI (p < 0.01).ConclusionsWe established reference intervals of PNI in healthy Han Chinese population in Western China and validated successfully. Further established RIs will lead to better standardizations of PNI for clinical applications.     

Cardiac Tissue-Mimicking Ballistic Gel Phantom for Ultrasound Imaging in Clinical and Research Applications

Ballistic gel was investigated as a tissue-mimicking material in an anthropomorphic cardiac phantom for ultrasound imaging. The gel was tested for its acoustic properties and its compatibility with conventional plastics molding techniques. Speed of sound and attenuation were evaluated in the range 2–12 MHz. The speed of sound was 1537 ± 39 m/s, close to typical values for cardiac tissue (∼1576 m/s). The attenuation coefficient was 1.07 dB/cm·MHz, within the range of values previously reported for cardiac tissue (0.81–1.81 dB/cm·MHz). A cardiac model based on human anatomy was developed using established image segmentation processes and conventional plastic molding techniques. Key anatomic features were observed, captured and identified in the model using an intracardiac ultrasound imaging system. These favorable results along with the material's durability and processes that allow for repetitive production of detailed whole-heart models at low cost are promising. There are numerous applications for geometrically complex phantoms in research, training, device development and clinical use.