Patellofemoral joint arthroplasty: patient selection,surgical technique and outcomes

Isolated patellofemoral arthritis is an increasingly recognized entity, and is usually associated with previous patellofemoral dysplasia or instability. Patellofemoral arthroplasty (PFA) has evolved significantly in recent years, both in terms of implant design and importantly in the understanding of appropriate patient selection. This review outlines the indications and investigations for PFA, provides a brief history of the development of contemporary implants, and presents the clinical outcomes for the prostheses most commonly used in the UK. In addition, it provides a detailed surgical technique for implantation of an onlay implant, with tips on how to optimize patellofemoral biomechanics and thus achieve a consistently good outcome.     

Platelet additive solutions: A future perspective

Platelet additive solutions (PASs) were first developed in the 1980s, and continued to be improved over the following years. The use of PASs as replacement for plasma has a number of benefits, both for the quality of the platelet concentrates and for the patients. However, some PASs have been associated with a lower platelet yield in the PCs, a shorter storage time, and a lower increment in the patient when compared to PCs in plasma. A number of reformulations of the PASs have taken place to counteract these disadvantages. Most PASs use acetate as nutrient for the platelets, which has the benefit of generating bicarbonate when oxidized by the platelets, thus supplying its own buffering capacity. Alternatively, glucose is used, but may cause deterioration of pH in the stored PCs due to the formation of lactic acid. Addition of other buffering substances, such as phosphate, can be added to ensure maintenance of neutral pH. An important finding was the inhibiting effect of potassium and magnesium on platelet activation. The initially developed PASs lacked these two ingredients and showed reduced storage times of the PCs in PAS when compared to those stored in plasma. However, when these constituents are included in the PAS, storage time is similar and even exceeds those seen for PCs in plasma. Considerable research is done in further formulating the optimal PAS. Bicarbonate is being considered as buffer for these PASs. Also, L-carnitine appears to have a favorable effect on stored platelets, including a reduction of platelet metabolism, and inhibition of apoptosis. Another area of optimization is lowering of plasma content needed for maintaining platelet quality. Where current PASs still need at least 30% residual plasma, there is a trend towards lowering the plasma content to less than 5% with the newer PASs. Preservation of purinergic platelet receptor functionality by ADP-degrading activities in plasma appears to play an important role in this respect. Development of PASs are usually based on in vitro studies alone. It is important to realize that only clinical studies can give definitive answers about the quality of platelets stored in PASs. Sofar, only limited clinical evaluations have been published that either studied the effectiveness of platelets in initially-developed PASs, or were specifically done in combination with pathogen reduction technologies. Thus, PASs seem to be an excellent replacement for (part of) the plasma when producing PCs, and allow extended storage with maintenance of quality, but more clinical studies are needed to substantiate in vitro results.     

药店药师在岗履职过程中存在的矛盾及对策

目的:探讨药店药师在岗履职过程中存在的矛盾。方法:具体分析现存的矛盾。结果与结论:解决矛盾应注重宣传教育;严格实行药师考核制度,从严管理“挂名药师”;加大监督检查力度,确立有章可循的药师管理制度。     

女性高屈曲度假体与普通高屈曲度假体治疗女性膝骨关节炎的近期临床疗效比较

背景：全膝关节置换术（total knee arthroplasty,TKA）已成为治疗膝骨关节炎（osteoarthritis of the knee,OA）的有效方法。但在治疗满意度上,男女之间差别较大。 目的：比较采用Gender Solutions Nex-Gen膝关节假体与普通高屈曲度假体治疗女性膝骨关节炎的近期临床疗效。 方法：2008年3月至2011年11月,55例（79膝）女性OA患者接受全膝关节表面置换手术。A组：24例37膝,采用Gen-der Solutions Nex-Gen膝关节假体（美国Zimmer公司）;B组：31例42膝,采用普通高屈曲度假体（美国Zimmer公司）治疗。对比两组手术并发症、KOOS （Knee injury and Osteoarthritis Outcome Score）评分、主观满意指数（satisfaction in-dex,SI）、膝关节活动度、膝关节最大屈曲度、膝前疼痛发生率。 结果：55例患者中4例失访,平均随访35.2个月（24~50个月）,KOOS各项评分两组间比较无统计学意义（P〉0.05）,但组内比较均有统计学意义（〈0.01）。组间及组内膝关节活动度、最大屈曲度比较差异均有统计学意义（〈0.01）。组间主观满意度比较有统计学意义（〈0.01）。A组下肢静脉血栓1例,给予抗凝治疗后痊愈;B组膝关节浅度感染1例,膝前反复痛7例,两组膝前疼痛率比较有统计学意义（〈0.05）。两组病例无膝关节僵直、神经血管损伤、假体松动。 结论：Gender Solutions Nex-Gen与普通高屈曲度假体均能有效治疗女性膝骨关节炎,但Gender Solutions Nex-Gen膝关节假体符合女性膝关节解剖,满意度、临床疗效更高。     

Addressing medication errors in an adult oncology department in Saudi Arabia: A qualitative study

ObjectiveThere is a wide range of strategies that could help in minimizing medication errors during healthcare delivery. We undertook a qualitative study to identify recommended solutions to minimize medication errors in an adult oncology department in Saudi Arabia from the perspectives of healthcare professionals.MethodsThis was a qualitative study conducted in an adult oncology department in Saudi Arabia. After obtaining the required ethical approvals and written consents from the participants, seven focus group discussions were carried out for data collection. A stratified purposive sampling strategy was used to recruit medical doctors, pharmacists, and nurses. NVivo Pro version 11 was used for data analyses. Inductive content analysis was adopted in the coding of collected data.ResultOur study showed that improving organizational support, staff education, and communication could help in minimizing medication errors in the adult oncology department.ConclusionThe adoption of multiple strategies is required to improve the safety of the medication process in the adult oncology department. We argue that the availability of supportive leadership should be prioritized as it plays a crucial role in determining the effectiveness and efficiency of both staff education and communication.     

影响中药贮藏的因素及其库存管理方法探讨

随着我国医疗机构现代化管理的发展与药品循环流通制度的改革,就药品库存进行科学管理,成为目前需要解决的一大难题。由于中药的特性,其与一般西药相比,库存管理的问题更多,如处理不当,易引发药物质量问题,轻则影响疗效,重则危及患者健康。目前,药品采购计划不周、药品仓库管理工作人员相对不足、存在库存账、物不符等现象以及药品有效期管理混乱等均为影响中药贮藏的重要因素。而通过制定库存管理制度,严格执行国家相关法律、法规,完善中药药品库存管理体系,强化药品库管人员素质,严格把关入库,中药分类贮存,定期核查中药药品库存,做好库存重要药品养护,均可以较大程度上改善目前各类中药贮藏问题。     

病案缺陷质量分析

目的对病案缺项问题进行分析并提出解决方案,保证病案的完整性。方法对2010年1578份缺项病案进行分类、统计和分析。结果病案书写打印不及时、科室缺乏有效管理、对病案质量重要性认识不足、医护人员工作量大等因素是造成病案缺项的主要原因。结论医院信息系统的整合,合理配置医疗资源,提高医生对病案质量重要性认识,加快电子病历试点工作的完成,才能减少甚至消除病案质量的缺项问题,全面提高病案质量。     

农村健康社区的构建：困境与对策

健康社区是一个包括健康人群、健康环境和健康社会有机结合的整体。建设农村健康社区对于促进农村社会和谐,实现农村公共卫生和基本医疗服务均等化,提升农村社区居民的健康保障水平具有重大的现实意义。目前,构建农村健康社区遭遇一系列困境。针对这些困境进行分析,尝试性地提出走出困境的对策。