Patient Blood Management: Use of Topical Hemostatic and Sealant Agents

Patient blood management is the scientific use of safe, effective medical and surgical techniques designed to conserve blood, prevent anemia, decrease bleeding, and optimize coagulation in an effort to improve patient outcomes. Perioperative and primary care nurses play a vital role in promoting and making the best use of patient blood management and can play a key role in implementing effective strategies that decrease or eliminate patient exposure to allogeneic blood. The fast and effective minimization of intraoperative bleeding is integral in an effective blood management program. Topical hemostatic and sealant agents can be used to improve blood conservation, reduce overall procedure time, and contribute to faster patient recovery based on specific clinical situations. The proper selection of hemostatic agents can greatly influence the patient’s clinical outcomes.     

丹芩消郁合剂治疗乳腺增生病疗效观察

目的:观察丹芩消郁合剂治疗乳腺增生病的临床疗效。方法:将80例乳腺增生病患者随机分为治疗组和对照组各40例,治疗组给予丹芩消郁合剂治疗,对照组给予消癥丸治疗,2个月为1个疗程,疗程结束后评价疗效。结果:两组患者治疗的总有效率均为92.5%,比较其差异无统计学意义(P0.05);两组愈显率分别为:治疗组52.5%,对照组30.0%,两组比较,差异有统计学意义(P0.05)。结论:丹芩消郁合剂治疗乳腺增生病疗效优于消癥丸。     

HPLC法测定蛇伤Ⅱ号合剂中大黄酚的含量

目的建立HPLC检测法测定蛇伤Ⅱ号合剂中大黄酚的含量。方法采用C18柱(4.6mm×250mm,5μm);流动相为甲醇-0.1%磷酸溶液(72:28),流速为1.0m L·min-1;检测波长254nm。结果大黄酚在8.580~171.600ng的范围内呈良好的线性关系(r=1.0000),平均回收率为96.71±0.96(RSD为0.99%)。结论该法具有良好的精密度和重现性,结果准确可靠,可用于蛇伤Ⅱ号合剂中大黄酚的含量测定。     

New legal requirements for submission of product information to poisons centres in EU member states

Introduction: In the past eight years, the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) has been intensively involved in a European Commission led process to develop EU legislation on the information of hazardous products that companies have to notify to EU Poisons Centres (or equivalent “appointed bodies”). As a result of this process, the Commission adopted Regulation (EU) No 2017/542, amending the CLP Regulation by adding an Annex on harmonised product submission requirements.

Harmonised mixture information requirements: Detailed and consistent information on the composition of the hazardous product will become available to EU Poisons Centres (PC). The information will be submitted by companies to PCs (or equivalent “appointed bodies”) using a web-based software application or in-house software. Two new important features are introduced. Firstly, to be able to rapidly identify the product formula, a Unique Formula Identifier (UFI) on the product label links to the submitted information. Secondly, for better comparability of reports on poisonings between EU member states, a harmonised Product Categorisation System will specify the intended use of a product. Rapid product identification and availability of detailed composition information will lead to timely and adequate medical intervention. This may lead to considerable reduction in healthcare costs.

Additionally, for companies trading across the EU, costs of submission of this information will be reduced significantly.

Next steps: From 2017, an implementation period has started, consisting of a three-year period for stakeholders to implement the new requirements, followed by a gradual applicability for consumer products (2020), professional products (2021) and industrial use-only products (2024). Technical tools to generate the electronic format and the UFI together with guidance documents are expected to be made available by the end of 2017 by the European Chemicals Agency (ECHA). Guidance on interpretation of legal text and ECHA helpdesk support are planned to be ready at the end of 2018.     

Power calculations for delta‐adjusted pattern‐mixture models

Pattern‐mixture models provide a general and flexible framework for sensitivity analyses of nonignorable missing data in longitudinal studies. The delta‐adjusted pattern‐mixture models handle missing data in a clinically interpretable manner and have been used as sensitivity analyses addressing the effectiveness hypothesis, while a likelihood‐based approach that assumes data are missing at random is often used as the primary analysis addressing the efficacy hypothesis. We describe a method for power calculations for delta‐adjusted pattern‐mixture model sensitivity analyses in confirmatory clinical trials. To apply the method, we only need to specify the pattern probabilities at postbaseline time points, the expected treatment differences at postbaseline time points, the conditional covariance matrix of postbaseline measurements given the baseline measurement, and the delta‐adjustment method for the pattern‐mixture model. We use an example to illustrate and compare various delta‐adjusted pattern‐mixture models and use simulations to confirm the analytic results. Copyright © 2014 John Wiley & Sons, Ltd.     

A random pattern mixture model for ordinal outcomes with informative dropouts

We extend a random pattern mixture joint model for longitudinal ordinal outcomes and informative dropouts. The patients are generalized to ‘pattern’ groups based on known covariates that are potentially surrogated for the severity of the underlying condition. The random pattern effects are defined as the latent effects linking the dropout process and the ordinal longitudinal outcome. Conditional on the random pattern effects, the longitudinal outcome and the dropout times are assumed independent. Estimates are obtained via the Expectation–maximization algorithm. We applied the model to the end‐stage renal disease data. Anemia was found to be significantly affected by the baseline iron treatment when the dropout information was adjusted via the study model; as opposed to an independent or shared parameter model. Simulations were performed to evaluate the performance of the random pattern mixture model under various assumptions. Copyright © 2015 John Wiley & Sons, Ltd.     

养阴活胃合剂对慢性萎缩性胃炎模型大鼠血清炎症因子的影响

目的探讨养阴活胃合剂对慢性萎缩性胃炎(CAG)模型大鼠血清炎症因子含量的影响及其作用机制。方法将实验动物随机分为6组:空白对照组、模型组、阳性药物对照组及中药低剂量组、中剂量组、高剂量组,每组16只。除空白对照组常规饲养、自由进食水之外,其余5组将2 g水杨酸钠加入100 m L的30%乙醇溶液中,给大鼠灌胃,每日1次,每次3 m L,配合隔日喂食不禁水法建立大鼠萎缩性胃炎模型,模型复制成功后中药治疗低、中、高剂量组分别喂饲养阴活胃合剂水煎剂0.74 g·kg-1·d-1、1.48 g·kg-1·d-1和2.22 g·kg-1·d-1。12 w后测定血清中IL-6、TNF-α、IFN-β及NOS2含量。结果养阴活胃合剂能够改善大鼠胃黏膜病理状态,使病变胃黏膜趋于正常。与空白对照组比较,各组IL-6、TNF-α、IFN-β及NOS2均明显升高(P<0.05),证明模型复制成功。与模型组相比,中药高剂量组TNF-α、IL-6、NOS2均明显降低,差异有统计学意义(P<0.05),中药中剂量组IFN-β降低,差异有统计学意义(P<0.05)。结论养阴活胃合剂可降低慢性萎缩性胃炎大鼠血清中炎症因子水平,而抑制炎症反应可能有助于慢性萎缩性胃炎病情的改善。     

桡动脉穿刺介入术后止血方法的比较

目的:比较不同止血方法在桡动脉穿刺介入术后的止血效果,并探讨其护理方法及效果.方法:选取于本院进行桡动脉穿刺介入术干预的84例患者为研究对象,将其随机分为A组(加压弹力绷带组)42例和B组(桡动脉充气止血器组)42例,对两组均进行针对性护理,并将两组的肿胀、疼痛及麻木程度、止血时间及干预前后的局部微循环指标进行统计及比较.结果:B组的肿胀、疼痛及麻木程度均轻于A组,止血时间短于A组,干预后不同时间的局部微循环优于A组,差异具有统计学意义(P＜0.05),且两组均对护理满意率为100.00％.结论:桡动脉充气止血器在桡动脉穿刺介入术后止血中的效果相对较好,辅以针对性护理更受患者欢迎.     

克银合剂治疗血热型白疕疗效及对肿瘤坏死因子-α的影响

目的 研究克银合剂治疗血热型白疕(寻常型银屑病)疗效及对肿瘤坏死因子-α(TNF-α)的影响.方法 选取30例寻常型银屑病血热型患者作为研究对象,进行克银合剂治疗,另选取同期接受健康体检的健康人30例作为对照组,研究克银合剂对TNF-α的影响.结果 治疗前TNF-α水平显著高于健康对照组,进行克银合剂治疗后患者症状、体征评分均显著低于治疗前,各项指标水平已经接近对照组.结论 克银合剂能改善寻常型银屑病血热型患者的临床症状,对TNF-α异常也有一定的改善作用.     

银僵合剂治疗坏死性淋巴结炎

目的 观察3型坏死性淋巴结炎患者的临床表现以及银僵合剂对3型坏死性淋巴结炎的疗效.方法 根据病理分型将坏死性淋巴结炎患者分为3组:增生(PT)组29例、坏死(NT)组30例、黄色瘤型(XT)组28例,均给予银僵合剂内服加外熏.观察3组临床表现及治疗前后中医证候积分的变化.结果 PT、NT组中医证候积分明显高于XT组(P＜0.05).3组总有效率及复发率分别为PT组96.55％、3.60％;NT组96.66％、3.44％;XT组89.28％、4.00％,PT组与NT组比较无统计学意义(P＞0.05),与XT组比较有统计学意义(P＜0.01).结论 3组临床表现存在差异;银僵合剂在PT、MT2组中的疗效优于XT组.