尼莫地平纳米脂质体包封率测定方法的研究

目的　建立尼莫地平纳米脂质体的包封率测定方法。方法　以高效液相色谱法为分析手段 ,采用反透析法测定尼莫地平纳米脂质体的包封率。结果　反透析法透析平衡时间为 6h ,游离药物回收率符合要求 ;此法测得自制尼莫地平纳米脂质体的平均包封率为 85 6 9%± 3 13% ,10h内无渗漏 ,方法重现性好。结论　反透析法便捷、准确 ,适用于脂溶性药物尼莫地平纳米脂质体的包封率测定。     

伤寒Vi多糖菌苗免疫后长期效果观察

目的研究伤寒Vi多糖菌苗免疫后长期效果。方法现场实验流行病学。结果接种后伤寒Vi多糖菌苗1~3年的有一定的保护作用,且在这3年中保护效果无差别。结论接种伤寒Vi多糖菌苗是今后预防伤寒的重要措施之一,但不必要每年均接种。     

鲁沃夫清洗液在内镜清洗中的应用

目的观察鲁沃夫(Ruhof)多酶清洗液在内镜中的应用效果。方法对使用后的内镜80例次采用卫生部规定的四槽法进行多酶清洗液清洗,观察清洗后镜身表面附着物、喷嘴堵塞、内镜表面清洁度的变化。结果Ruhof多酶清洗液清洗后,镜身表面附着物、喷嘴堵塞、表面清洁度评价值显著下降,清洗前后差值比较差异有统计学意义(P<0.01)。结论Ruhof多酶清洗液是一种理想的内镜清洗剂,能有效清洗,减少医源性交叉感染的发生。     

尼莫地平纳米脂质体包封率测定方法的研究

目的　建立尼莫地平纳米脂质体的包封率测定方法。方法　以高效液相色谱法为分析手段 ,采用反透析法测定尼莫地平纳米脂质体的包封率。结果　反透析法透析平衡时间为6h ,游离药物回收率符合要求;此法测得自制尼莫地平纳米脂质体的平均包封率为85.69%±3.13% ,10h内无渗漏,方法重现性好。结论　反透析法便捷、准确 ,适用于脂溶性药物尼莫地平纳米脂质体的包封率测定。     

便携式野战预真空三氧消毒灭菌器的研制

目的:目前在野战条件下消毒灭菌多为使用小型消毒锅或消毒挂车,而使用高温高压蒸汽进行消毒工作,对水、电的要求高,且危险性高、工作效率低,影响了卫勤保障能力。遂行多样化卫勤任务急需一种简便可靠、实用性强的消毒灭菌设备。方法:采用三氧代替高压蒸汽进行消毒灭菌,利用三氧的强氧化性杀灭各种病原体,具有消毒作用迅速、无二次污染、造价低廉等特点。工作流程为:首先对密闭容器进行预真空处理,排出空气后产生三氧,达到所需浓度后可保持一定时间。结果:紧密贴合部队实战需要,研究成功后可在部队列装,将彻底改变目前野战条件下高压蒸汽消毒灭菌的局限性,提高卫勤保障能力,具有极高的军事和经济价值。结论:便携式野战预真空三氧消毒灭菌器适合军队野战状态下医疗器械的消毒灭菌工作。     

The unexpected outcomes of the closure of 67 inpatient care facilities in 2011 in Romania

One of the main objectives of the National Strategy for Hospitals Rationalization approved by the Romanian Government in 2011 was to resize the hospital sector in order to improve efficiency. To this end, the government decided the closure of 67 inpatient care facilities with low efficiency scores, giving them the opportunity to become nursing homes for elderly under a national programme financed by the Ministry of Labour, Family and Social Protection. The measure faced a tremendous public opposition that put pressure on politicians to re-open some hospitals, while other hospitals were re-opened by the governments that followed in order to consolidate their power. Since only 20 closed institutions have been reorganized as nursing homes for elderly and almost 40 are currently performing medical activities, this decision was generally perceived as a policy failure. Nevertheless, a thorough analysis, shows that the medical facilities that are still functioning - either merged with other hospitals, or re-organized as state or private medical institutions have improved efficiency by reshaping services provided to the population needs, mobilizing communities and local authorities investments and initiating public-private partnerships. Besides revealing the unexpected benefits resulted from the implementation of this policy, the Romanian experience provides some useful insights for other countries that are also facing the challenge of reducing the oversized hospital sector.     

Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe?

IntroductionHistorically, it has been assumed that Intermediate Respiratory Care Units (IRCU) were efficient, because they saved costs by reducing the number of admissions to intensive care units (ICU), and effective, because they specialized in respiratory diseases.MethodsThe number of IRCU admissions and mortality rate, historically and in 2016, were evaluated. For 2016, the grouped Related Diagnostic Groups (DRGs) were also described, and the savings achieved under all budgetary headings by avoiding UCI stays were calculated. A multivariate analysis was performed to associate costs with mean weights and complexity, and multiple logistic regression was performed on all patients admitted from 2004 to 2017 to describe the variables associated with mortality in our unit.ResultsAn IRCU generates savings of €500,000/year by reducing length of ICU stay. Analysis of the 2016 cohort shows that costs correlate with mean weight and mortality, and consequently complexity. The multivariate logistic regression analysis of the 2004–2017 cohort found respiratory frequency, leukopenia, anemia, hyperkalemia, and acidosis to be the variables best associated with mortality. The area under the curve for the logistic model was 0.75.ConclusionThe IRCU analyzed in our study was efficient in terms of ‘avoided costs’ and savings associated with complexity. Our results suggest that IRCUs have a lower mortality rate than other similar units, and are therefore a safe environment for patients.     

Antiplatelet therapy and outcomes following endovascular therapy for acute ischemic stroke: A systemic review and meta-analysis

ObjectiveThe outcomes of antiplatelet therapy (APT) in patients with acute ischemic stroke (AIS) receiving endovascular therapy (EVT) remains controversial. Thus, we sought to make a systematic review and meta-analysis of recent clinical trials to confirm the safety and efficacy of APT.MethodsAll of clinical trails were systematically retrieved from PubMed, Embase and Cochrane. The endpoints or main outcome measures included symptomatic intracranial hemorrhage (sICH), 3-month mortality, successful recanalisation (SR) and 3-month functional independence (FI). Odd ratios (ORs) with their 95% confidence intervals (CIs) were calculated to synthesize effect size by using random-effects models. Sensitivity analysis was performed via calculation of rest data owiting one by one.Results23 articles were included after screening. APT as an adjunct to EVT was associated with a higher likelihood of pooled successful recanalisation (OR 1.46, 95% CI 1.07–2.00) and 3-month FI (OR 1.24, 95% CI 1.01–1.51), no associated with sICH and 3-month mortality. However, Sensitivity analysis indicated that the association between APT and SR and 3-month FI were unstable. For patients with prior use of APT or receiving intravenous thrombolysis before EVT, no associated were found between APT and all of endpoints above.ConclusionAlthough adjuvant APT appears to increase the number of SR and 3-month FI, the results were unstable. Randomised controlled trials are needed to confirm the efficacy.     

Automatic Extraction of Comprehensive Cardiac CT Angiography Parameters: A Novel Program with High Accuracy and Efficiency

We tested the accuracy and efficiency of a novel automated program capable of extracting 15 cardiac computed tomography angiography (CTA) parameters from clinical CTA reports. Five hundred cardiac CTA reports were retrospectively collected and processed. All reports were pre-populated with a structured template per guideline. The program extracted 15 parameters with high accuracy (97.3 %) and efficiency (84 s). This program may be used at other institutions with similar accuracy if its report format follows the Society of Cardiovascular Computed Tomography (SCCT) guideline recommendation.     

Measuring the performance of patient-specific solutions for minimally invasive transforaminal lumbar interbody fusion surgery

Pre-surgical planning using 3D-printed BioModels enables the preparation of a “patient-specific” kit to assist instrumented spinal fusion surgery. This approach has the potential to decrease operating time while also offering logistical benefits and cost savings for healthcare. We report our experience with this method in 129 consecutive patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) over 27 months at a single centre and performed by a single surgeon. Patient imaging and surgical planning software were used to manufacture a 3D-printed patient-specific MIS TLIF kit for each patient consisting of a 1:1 scale spine BioModel, stereotactic K-wire guide, osteotomy guide, and retractors. Pre-selected pedicle screws, rods, and cages were sourced and supplied with the patient-specific kit. Additional implants were available on-shelf to address a size discrepancy between the kit implant and intraoperative measurements. Each BioModel was used pre-operatively for surgical planning, patient consent and education. The BioModel was sterilised for intraoperative reference and navigation purposes. Efficiency measures included operating time (153 ± 44 min), sterile tray usage (14 ± 3), fluoroscopy screening time (57.2 ± 23.7 s), operative waste (19 ± 8 L contaminated, 116 ± 30 L uncontaminated), and median hospital stay (4 days). The pre-selected kit implants exactly matched intraoperative measurements for 597/639 pedicle screws, 249/258 rods, and 46/148 cages. Pedicle screw placement accuracy was 97.8% (625/639) on postoperative CT. Complications included one intraoperative dural tear, no blood products administered, and six reoperations. Our experience demonstrates a viable application of patient-specific 3D-printed solutions and provides a benchmark for studies of efficiency in spinal fusion surgery.