Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection,donation timing,logistics, and regulatory compliance

Live and deceased kidney donation by the numerous patients with advanced, progressive systemic neurological diseases, and other chronic neurological conditions (eg, high C‐spine injury) remains largely unexplored. In a review of our current clinical practice, we identified multiple regulatory and clinical barriers. For live donation, mandatory reporting of postdonation donor deaths within 2 years constitutes a strong programmatic disincentive. We propose that the United Network for Organ Sharing should provide explicit regulatory guidance and reassurance for programs wishing to offer live donation to patients at higher risk of death during the reporting period. Under the proposal, live donor deaths within 30 days would still be regarded as donation‐related, but later deaths would be related to the underlying disease. For deceased donation, donation after circulatory death (DCD) immediately following self‐directed withdrawal of life‐sustaining treatment (“conscious DCD”) is not universally covered by existing DCD agreements with donor hospitals. Organ procurement organizations should thus systematically strive to revise these agreements. Obtaining adequate first‐person consent from these communicatively severely impaired patients may be challenging. Optimized preservation and allocation protocols may maximize utilization of these DCD kidneys. Robust public debate and action by all stakeholders is necessary to lower existing barriers and maximize donation opportunities for patients with chronic neurological conditions.     

北京地区54家社区医院2009年1—6月药品采购情况分析

目的：研究北京地区54家社区医院2009年1—6月药品采购情况。方法：统计北京地区54家社区医院2009年1—6月药品采购数据,并进行分析。结果：社区医院使用的药物主要为抗感染药物、心血管系统药物、中药。各月基本稳定．中药采购量有较大波动。结论：感染和心血管常见疾病是社区医院的主要治疗对象。中药采购量与2009年的多起与中药注射液有关的医疗事故有关。     

二级医院医疗设备的维修与采购现状分析

据统计二级医院在国家注册的医院中占到总数的35%左右,一级(含以下)占到59%左右,三级医院占到6%左右。现代医院的发展和竞争逐步集中在人才和设备两个方面,设备科作为医院医疗设备管理的主要科室,肩负着重要的保障作用。科室的科学化管理将为临床一线提供强有力的保障。现根据我院设备科科室分工中存在的问题,有针对性地提出了自己的建议。     

Kidney accelerated placement project: Outcomes and lessons learned

Opportunities continue to be lost with a high rate of kidneys recovered for transplant but not utilized, particularly those considered less than ideal quality. The Organ Procurement and Transplantation Network (OPTN) Organ Center is tasked with allocating arguably the most difficult-to-place kidneys, and we hypothesized an accelerated placement pathway would increase utilization of kidneys placed by the Organ Center. The Kidney Accelerated Placement (KAP) project, implemented by the Organ Center from July 18, 2019 to July 15, 2020, aimed to offer kidneys with a high kidney donor profile index to programs that had a history of accepting such organs. We compared OPTN kidney match run, donor, and transplant recipient data during the project period and 1 year prior. There was no statistically significant change in the percentage of KAP-eligible donors accepted during the project period (16.4%) compared to the prior year (17.5%). Conversion from acceptance to transplant was higher under KAP (72.7% vs. 71.2%), though not significant. Waiting to accelerate placement after kidneys have been declined by multiple transplant programs locally and regionally is an intervention that may come too late to effectively increase utilization. Transplant rates of nationally shared and marginal kidneys remain a challenge, and future iterations of this project should be investigated.

     

Vaccines,inspiring innovation in health

This report covers the topics of pandemics, epidemics and partnerships, including regulatory convergence initiatives, new technologies and novel vaccines, discussed by leading public and private sector stakeholders at the 18th Annual General Meeting (AGM) of the Developing Countries Vaccine Manufacturers’ Network (DCVMN). Contributions of Gavi and the vaccine industry from emerging countries to the growing global vaccine market, by improving the supply base from manufacturers in developing countries and contributing to 58% of doses, were highlighted. The Coalition for Epidemic Preparedness Innovations (CEPI), the International Vaccine Institute (IVI) and others reported on new strategies to ensure speedy progress in preclinical and clinical development of innovative vaccines for future MERS, Zika or other outbreak response. Priorities for vaccine stockpiling, to assure readiness during emergencies and to prevent outbreaks due to re-emerging diseases such as yellow fever, cholera and poliomyelitis, were outlined. The role of partnerships in improving global vaccine access, procurement and immunization coverage, and shared concerns were reviewed. The World Health Organization (WHO) and other international collaborating partners provided updates on the Product, Price and Procurement database, the prequalification of vaccines, the control of neglected tropical diseases, particularly the new rabies elimination initiative, and regulatory convergence proposals to accelerate vaccine registration in developing countries. Updates on supply chain innovations and novel vaccine platforms were presented. The discussions enabled members and partners to reflect on efficiency of research & development, supply chain tools and trends in packaging technologies improving delivery of existing vaccines, and allowing a deeper understanding of the current public-health objectives, industry financing, and global policies, required to ensure optimal investments, alignment and stability of vaccine supply in developing countries.     

我国与GPA成员方及印度制剂产业外贸竞争力比较研究

产业的外贸竞争力决定其国际市场份额。对我国与GPA成员方以及印度的制剂产业外贸竞争力比较研究发现：我国制剂出口的国际市场占有率不足1%,贸易竞争优势指数为负值,显示性比较优势指数长期处于较低水平,制药产业外贸竞争力不仅与GPA成员相差悬殊,甚至明显落后于印度。因此,在我国制剂产业外贸竞争力取得长足进步之前,加入GPA难以改变目前我国单方面开放医药市场的现状,对我国制药产业很可能＂弊大于利＂。我国医药产业应借推行新版GMP和落实自主创新方略等政策的机会,加快企业＂走出去＂的步伐,争取在加入GPA之前成为真正的制药强国。     

某三甲综合性医院基层党支部加强采购行风建设机制研究

充分发挥公立医院党委的领导作用,履行全面从严治党主体责任,把基层党支部建设作为有力抓手,该文从风险防控角度分析医疗卫生行业设备及物资采购处岗位中的风险及关键点,探索构建风险明确、制度健全、宣教引导、监管有效的行风风险防控建设机制。     

高值医用耗材采购模式概述

高值医用耗材的采购管理对于控制医疗费用、规范医疗市场行为有重要意义。目前以医院为主体的高值医用耗材采购仍以科室需求为主导,采购部门仅负责谈判议价及货款报销等,被动性、灵活性及随意性较大;而以政府为主体的高值医用耗材集中采购则通过制定采购目录、减少流通环节等途径促进耗材的合理使用,并在很大程度上控制了医疗费用的过快增长。从医疗、社会、管理和政治等多方面来看,高值医用耗材采取集中招标采购模式是必然趋势。     

中医药院校外文数据库资源采购实践与探讨 ——以北京中医药大学为例

以北京中医药大学为例探讨中医药院校外文数据库资源采购问题,具体介绍资源采购前的准备工作,包括兄弟院校间调研、专家咨询、校园网内调研、数据库使用培训等共6个阶段,为中医药院校采购外文数据库资源提供建议。