Postmortem parenthood and the need for a protocol with posthumous sperm procurement

OBJECTIVE: Posthumous sperm procurement involves harvesting gametes from a recently deceased man for cryopreservation and future use in ART. This paper discusses the practical and ethical role of posthumous sperm procurement in medical practice and society and submits possible solutions, including the establishment of formal policies and protocols. DESIGN: English-language literature review and bioethical discussion. RESULT(S): In the United States, an increase in requests and protocols has been documented. International requests and regulation are variable. CONCLUSION(S): Posthumous sperm procurement is fraught with ethical dilemmas, including informed consent, privacy, inheritance, and child welfare. To establish appropriate medical practice, it is important to consider all stakeholders in the decision-making process. We believe that an acceptable and ethical resolution can be obtained only through the collaborative input of all involved parties. We have looked to U.S. and international sources for guidance in current practice and to gain insight into the formulation of future policies.     

2000～2002年上海地区医院用药状况分析

目的：了解并分析上海地区医院用药趋势。方法：根据上海47家医院提供的医院用药分析系统收集的2000～2002年资料进行分析。结果：购药总金额的趋势有增长，但增幅下降；进口药、合资药、国产药购药金额的结构百分比，进口药近3年保持稳定，合资药趋势稳中有降，国产药趋势则稳中有升；购药金额领先的前100个品种和前15个品种所占总金额之百分比，前2002年比2001年有所下降，而后变化不大。各大类排序，几年来除个别位置稍有变动外，多数类别均未改变。结论：用药趋势与医保改革、药品招标及药品价格调整等诸多因素有关，总体上用药增长态势趋缓。     

Searching for a better willingness to pay elicitation method in rural Nigeria: the binary question with follow-up method versus the bidding game technique

OBJECTIVES: To compare the theoretical validity and predictive validity of the binary with follow-up questions technique and the bidding game, using hypothetical and actual WTP for insecticide-treated nets (ITNs) in Nigeria. METHODS: Each elicitation method was applied in one of two rural communities in Enugu state, Nigeria. A pre-tested interviewer-administered questionnaire was administered to household heads or representatives of households. WTP was elicited in each after presenting the scenario and showing a sample of the ITNs to the respondents. Then, within an interval of 1-2 months, the nets were sold to the respondents to compare hypothetical and actual WTP. FINDINGS: Consistent slightly higher mean and median WTP amounts were elicited from Mbano where the bidding game was used. The WTP technique was able to predict WTP responses correctly in 75% and 85% of cases in Orba and Mbano, respectively. Chi-square analysis did not show any statistical difference in values from both communities (p>0.05). CONCLUSION: Though the two techniques yielded similar results, the thrust should be the development of a WTP elicitation method that best mimics the bargaining process in normal market situations in rural Nigeria. Such an indigenous technique will help improve the predictive validity of the contingent valuation method.     

Incidence and risk factors of preparation errors in a centralized cytotoxic preparation unit

Objective: A major objective of centralized preparation is to improve the quality of the final product, and thus their safety for the patient. Few data are available concerning errors occurring during preparation and the risk factors associated with the errors. To assess risk factors associated with preparation errors in a centralized cytotoxic preparation unit. Design: Medication errors were detected during preparation (selfeducation by technicians) or at the time of control (qualitative and semiquantitative). For each preparation, several potential risk factors were studied. Univariate analysis was carried out using Chi2 or Fisher exact tests. Variables with p<0.15 associated in univariate analysis were entered in a stepwise regression model. In an overall analysis, all types of error were considered. In a second analysis, only major errors (errors associated with drug, dose or major incompatibility) were studied. Results: Analysis included 30,819 preparations. Overall and major error rates were respectively 0.45% and 0.19%. The number of bottles (more than one), the volume of active solution (more than 50 ml) and the daily workload were the major risk factors identified by successive univariate and multivariate analysis. Conclusion: Low rates of medication errors compared to previous studies were reported. Major preparation errors were principally related to drug labeling (dose/bottle and concentration) and workload. Preparation mistakes appeared to have many causes. These results could be used to revise the general organization and determine a suitable purchasing policy.     

Organ Donor Screening Practices for Trypanosoma cruzi Infection among US Organ Procurement Organizations

Donor‐derived Trypanosoma cruzi infection in solid organ transplant recipients is associated with significant morbidity and mortality. Little is known about T. cruzi screening practices among U.S. organ procurement organizations (OPOs). We distributed a questionnaire to all U.S. OPO directors, requesting data on T. cruzi screening strategies, laboratory methods, number of donors screened, disposition of organs from positive donors and attitudes toward screening. Fifty‐eight (100%) U.S. OPOs responded to the survey. Donor screening began in 2002 and is presently performed by 11 (19%) OPOs. Among screening OPOs, four screen all donors and seven use a risk‐based strategy. Three different T. cruzi serology tests are used for donor screening. During 2008, 9/993 (0.9%) donors screened positive by a T. cruzi screening test, 6/9 (66%) had confirmatory tests performed and 4/6 (66%) had positive confirmatory tests. These results led to the nonuse of five donors and 17 organs. Five organs from three seropositive donors were transplanted in 2008 without recognized disease transmission. Variability of T. cruzi donor screening strategies, laboratory methods and disposition of organs from positive donors currently exists. Further research is needed to identify the risk of donor‐derived T. cruzi infections to help inform the best screening strategy.     

Baculovirus as delivery system for gene transfer during hypothermic organ preservation

Concerns over the safety of conventional viral vectors have limited the translation of gene transfer from an exciting experimental procedure to a successful clinical therapy in transplantation. Baculoviruses are insect viruses, but have the ability to enter mammalian cells and deliver potential therapeutic molecules with no evidence of viral replication. This study provides evidence of the ability of recombinant baculovirus to enter mammalian kidneys and livers during cold preservation. Six kidneys and six liver lobules retrieved from large pigs were perfused with University of Wisconsin (UW) solution containing a baculovirus tagged with green fluorescent protein and preserved for 8 h. In addition, six kidneys were perfused with UW containing a baculovirus expressing red fluorescent protein and preserved for 24 h. Green fluorescent virus particles were detected within transduced kidneys and livers after 8 h standard cold storage and red fluorescent protein mRNA was detected in kidneys after 24 h of cold preservation. There were no significant differences in tissue architecture, cell morphology or ATP content between experimental organs and their controls. Ex vivo transduction of organs with recombinant baculovirus during conventional cold preservation was demonstrated with no evidence of additional injury or reduction in cell viability.     

网上药品集中采购的方法探讨与应用

目的:利用电子商务网络平台进行药品集中采购.方法:应用计算机网络平台,对医院使用的所有招标药品实施网上集中采购.结果:网上药品集中采购切实可行,满足了国家六部委联合提出的医疗机构“网上药品集中采购”的要求.结论:网上药品集中采购具有科学、规范、安全、透明、快捷等优越性,值得广泛地推广应用.     

当前卫生系统政府采购的若干思考

我国的政府采购历经十多年时间的发展,已日益成熟和完善,取得可喜成绩.但当前卫生系统政府采购执行的过程中还存在采购周期过长、采购结果满意度低等问题.为提高卫生系统政府采购效率与效益,应法治建设注重“完”字,采购制度尝试“变”字,计划执行强调“前”字,从业人员加大“培”字,采购信息坚持“集”字.     

温岭市城乡集中式供水水质监测分析

目的:了解全市城乡集中式供水水质卫生状况,保障居民饮水安全。方法:全市10家集中式供水企业于丰、枯水期,采集水源水和出厂水各1份、末梢水3份,按照GB/T5750-2006、GB5749-2006进行检验和评价。结果:3年共采集水样300份,超标的多为微生物指标、游离余氯、浑浊度、pH值,大小型供水企业水质差异有统计学意义。结论:我市城乡饮用水受地理化学因素和工业污染的影响较小,主要受微生物的污染;卫生监督对象应以小型集中式供水企业为主。     

外来骨科手术器械集中管理

目的规范外来骨科手术器械的使用,降低医院感染发生率以及医院运行成本,减轻患者经济负担。方法对医院手术室外来器械管理现状的各个层面的逐一分析,找到目前制约医院手术室外来器械管理的真正问题,制定"关于外来手术器械的消毒灭菌管理规范"。结果外来骨科手术感染发生率由2009年11月前的2.13%降至2010年12月的0.5%。结论医院手术室外来器械管理是一个系统工程,必须多方协作,齐抓共管。