对精密医疗维修检测仪器管理的体会

随着科学技术的发展，医疗仪器也以飞快的速度向着电子化、自动化、计算机化发展，仪器越来越先进，结构越来越复杂、精密，这对医工科的维修工作提出了更高的要求。我院医工科作为全区的医疗设备三级维修站，负责胶东半岛驻军医院及团卫生队的医疗仪器维修安装任务。近几年来，由总部配发和自购了２０余万元的医疗仪器维修和检测设备，如何管好用好这些设备，更好地服务于临床和部队，使设备优势变为技术优势，是大家关心和亟待解决的问题。现将我们在维修检测仪器管理中的几点体会总结如下：①放置环境的要求：设备设置环境能否真正耐受震…     

加强医院医疗设备维修管理,提高维修技能

随着现代医疗电子科学技术的迅速发展,各种高、精、尖先进医疗设备不断推出,而这些智能化的先进设备在临床使用过程中,不可避免地会出现故障。为确保临床一线工作的顺利进行,维修管理工作就显得愈加重要。医疗设备的使用完好率,直接影响着医院的经济效益,为提高对医疗仪器装备的维修管理水平,将医疗仪器的维修管理工作做得更好。本文根据多年工作经验就如何管理好医院的维修工作、提高维修人员技术水平提出自己的看法。     

医疗仪器的维修管理

医疗仪器管理是医院医、教、研必不可少的基础工作。先进的仪器是医院实力的重要标志，是医院达标升级的基础条件。用好、管好仪器设备成为医院质量管理的一个重要课题。目前各级医院正在积极开展ISO认证工作，对医院管理提出了更严格的要求。其中，医疗仪器的维修管理直接关系到医院的效益。因此，必须加强对医疗仪器的维修与管理建设。     

进口医疗仪器维修探讨

近年来，在改革开放政策引导下，医院发展迅速。国外高科技的医疗仪器进入国内市场，充实提高了各级医院的医疗工作。实践证明，进口仪器使用率和寿命很大程度取决于维修的好坏。由此，进口医疗仪器的维修，已成为医院的一项重要的长期任务。     

医疗设备维修的基本步骤

<正>医疗设备是医院进行科学医疗的保证,需要其安全有效地运转。医疗设备大多属于精密仪器,价格昂贵,是现代科学的结晶,其维修虽具有多学科技术相互交叉、技术难度高等特点,但也不是无章可循,在长期的维修过程中,笔者总结出了维修检查的基本步骤,简介如下:     

医疗器械设备维修与管理体会

随着现代医学技术突飞猛进的发展,各种医疗器械层出不穷,不断更新,功能日见完善,电子化、专业化、自动化程度不断提高,结构也更加复杂。如何让医疗设备正常运转,更好地服务于患者,是每个医疗机构都非常关注的问题。     

临床医疗设备维修的问题与思考

随着临床对医疗设备的使用依赖性增加,医疗设备的维修越来越受到医疗管理体系的重视。但是因为医院管理的缺失、维修水平的落后以及临床使用时的不重视,导致设备的维修出现一系列的问题。针对这些问题,对临床医疗出现的有关问题做出思考并提出解决方案。     

浅谈医疗设备电源故障的维修

随着科学技术的飞速发展,各种各样的新型医疗设备层出不穷,为人们的健康保驾护航。不论设备功能多么先进、复杂,有一样东西是别不可少的,那就是电源,它是整个设备能量转换的动力源。尽管各种设备的原理不尽相同,但其电源的原理却大同小异。医疗设备中通常采用开关电源。开关电源具有功耗小、效率高的特点。在开关电源中,晶体管在激励信号的激励下,     

浅析医疗设备维修中存在的问题

随着现代医学的迅猛发展,各类先进的医疗设备不断进入医院,医疗设备在现代临床诊疗活动中有着举足轻重的作用。在迅速更新各类医疗设备的同时,与之配套的设备维修工作也越来越频繁而重要。维修工作直接影响着设备的使用及医疗技术的应用,并能直接或间接影响医院的经济效益等现实问题,然而在对医疗设备的维修中还存在着各种各样的问题,严重制约着维修效率,影响着医疗技术的应用。本文结合多年维修工作实际分析了医疗设备维修中存在的问题,并提出了相应的解决措施,对医院医疗设备维修的发展具有借鉴意义。     

Antique, archaic and arcane dermatologic instrumentation and armamentarium

Numerous instruments and devices have been used by dermatologists, other physicians and lay practitioners through the ages to treat skin, hair, nails, venereal diseases, and fat. And there have often been overlaps among the antique, the arcane, the bogus, and the new.     

Role of micafungin in the antifungal armamentarium

Serious infections caused by opportunistic molds remain a major problem for public health. Immune deficiency following organ transplantation and aggressive cancer treatment has greatly increased the incidence of systemic mycoses, and invasive aspergillosis in patients with AIDS is associated with significant morbidity and mortality. Amphotericin B is the first-line therapy for systemic infection because of its broad-spectrum and fungicidal activity. However, considerable side effects limit its clinical utility. The echinocandins are large lipopeptide molecules that inhibit the synthesis of 1,3-beta-D-glucan, a key component of the fungal cell wall. Three echinocandins have reached the market, and some others are in early clinical development. Caspofungin was the first echinocandin to be licensed for clinical use in most countries. Micafungin is licensed for clinical use in Japan, China, Taiwan, Jordan, Korea, Hong-Kong and the US, and anidulafungin is currently licensed in the US. The novel class of echinocandins represents a milestone in antifungal drug research that has further expanded our therapeutic options. Studies to date have shown that micafungin exhibits extremely potent antifungal activity against clinically important fungi, including Aspergillus and azole-resistant strains of Candida. In animal studies, micafungin is as efficacious as amphotericin B with respect to improvement of survival rate. Micafungin is also characterized by a linear pharmacokinetic profile and substantially fewer toxic effects. Micafungin is a poor substrate for the cytochrome P450 enzymes, and compared to azoles, fewer drug interactions are described. No dose adjustments of the drug are required in the presence of mycophenolate mofetil, cyclosporin, tacrolimus, prednisolone, or sirolimus. Strategies using this new echinocandin agent will benefit a large number of patients with severe immune dysfunction.     

A clinical armamentarium of marine-derived anti-cancer compounds

The sea, covering 70% of the Earth's surface, offers a considerably broader spectrum of biological diversity than terra firma. Containing approximately 75% of all living organisms, the marine environment offers a rich source of natural products with potential therapeutic application. Marine organisms have evolved the enzymatic capability to produce potent chemical entities that make them promising sources of innovative cytotoxic compounds. Prominent in the identification and development of novel anti-cancer agents from marine sources is the Spanish biotechnology company, PharmaMar, which currently has a large number of oncology products in late preclinical and clinical development. These include: ecteinascidin-743 (ET-743), a marine-derived antitumor agent isolated from the Caribbean tunicate, Ecteinascidia turbinata; aplidine (Aplidin), a cyclopeptide cytotoxic agent derived from the Mediterranean tunicate, Aplidium albicans; kahalalide F, a depsipeptide isolated from the Hawaiian mollusc, Elysia rufescens; and ES-285, a molecule isolated from the mollusc, Spisula polynyma. Many of these innovative compounds have novel mechanisms of anti-tumor action that have yet to be fully elucidated.     

New additions to the intensive care armamentarium

Many advances have improved the care of critically ill patients, but only a few have been through the use of pharmaceutical agents. Recently, the US Food and Drug Administration (FDA) approved drotrecogin alfa (activated), or recombinant human activated protein C, for the treatment of patients with a high risk of death from severe sepsis. Drotrecogin alfa (activated) has antiinflammatory, antithrombotic and fibrinolytic properties. When given as a continuous intravenous infusion, recombinant human activated protein C decreases absolute mortality of severely septic patients by 6.1%, resulting in a 19.4% relative reduction in mortality. The absolute reduction in mortality increases to 13% if the population treated is restricted to patients with an APACHE II score greater than 24, as suggested by the FDA. The most frequent and serious side effect is bleeding. Severe bleeds increased from 2% in patients given placebo to 3.5% in patients receiving drotrecogin alfa (activated). The risk of bleeding was only increased during the actual infusion time of the drug, and the bleeding risk returned to placebo levels 24 hours after the infusion was discontinued. Patients treated in the intensive care unit frequently develop anemia, usually severe enough to require at least one transfusion of red blood cells. With the recent discovery of the harmful effects of allogeneic red blood cell transfusions and the increasing shortage of available red blood cell products, emphasis has been placed on minimizing transfusions. Patients who receive exogenous recombinant human erythropoietin maintain higher hemoglobin levels, in spite of requiring fewer transfusions during their stay in the intensive care unit. Recombinant human erythropoietin appears to be effective whether it is given as 300 units/kg of body weight subcutaneously every other day or as 40,000 units subcutaneously every week. Differences in hemoglobin values were not apparent until at least one week of therapy, but they continued to diverge after that initial week. Furthermore, the incidence of adverse events was similar to that of patients receiving placebo and there was no difference in mortality, suggesting that avoidance of blood transfusions did not translate into increased survival. Thus, recombinant human erythropoietin appears to be both safe and effective in treating the anemia found in critically ill patients, but it is less clear that such treatment is cost effective, especially in the higher dose regimens. Hypotension in patients with septic shock is often difficult to correct. Despite enormous dosages of catecholamines, many of these patients continue to have inadequate blood pressures. Inadequate levels of vasopressin have been identified in patients with septic shock, as well as in other patients with hypotension secondary to refractory vasodilatation. Vasopressin is a peptide hormone secreted from the posterior pituitary in response to hyperosmolality, hypovolemia or hypotension. Levels of vasopressin initially rise in patients with septic shock, but as hypotension persists, vasopressin levels fall below normal. Administration of exogenous vasopressin in physiologic dosages significantly increases blood pressure in patients with shock associated with sepsis and other vasodilatory states. This rise in blood pressure is often significant enough that endogenous catecholamines can be decreased and frequently discontinued entirely. Early withdrawal of the vasopressin replacement infusion results in recurrent hypotension. Unfortunately, randomized, blinded, placebo-controlled trials showing improvement in long-term outcomes such as mortality and length of stay are still lacking.     

The role of caspofungin and the echinocandins in the antifungal armamentarium

The echinocandins are a recently-developed class of antifungal agents that interfere with fungal cell wall synthesis through the inhibition of glucan synthesis. Although several intravenous preparations are in various stages of development, caspofungin is the only currently approved agent and no oral echinocandin derivatives are presently available. Caspofungin is approved for the treatment of invasive aspergillosis in patients who are refractory to, or intolerant of, other antifungal therapies. This agent has activity against most Candida species, and in a prospective randomized trial, was as effective as, and better tolerated than amphotericin B in the treatment of candidal esophagitis. Activity against the cyst form of Pneumocystis carinii has also been demonstrated. Caspofungin is administered in a daily intravenous dose, and is well tolerated. Concomitant use of this agent with cyclosporine is presently not recommended. Other echinocandin derivatives presently in phase II/III clinical development include micafungin and anidulafungin.     

Management of relapse in naltrexone maintenance for heroin dependence

Opioid dependence is a growing public health problem. Maintenance on the antagonist naltrexone for clinic- or office-based treatment of opioid dependence is plagued by high rates of relapse. This paper identifies critical determinants of lapses to opioid use during naltrexone maintenance. Time retained in treatment was examined as a function of whether lapses to opioid use occurred while adherent to naltrexone (blocked use), or after having missed naltrexone doses (unblocked). METHOD: Participants (N=83) met DSM-IV criteria for opioid dependence and identified a significant other willing to participate in their treatment. Following inpatient detoxification, participants were enrolled in a 26-week outpatient course of therapy and naltrexone maintenance. RESULTS: Patients with unblocked use had a very high rate of dropout (10% retained at 6 months), dropout usually occurring within 2 weeks after unblocked use. Patients with only blocked use had less dropout (33% retained at 6 months). However, episodes of blocked use were often followed by unblocked use and dropout. CONCLUSIONS: During naltrexone maintenance for opioid dependence unblocked opioid use calls for immediate intervention, such as detoxification or switching to the partial agonist buprenorphine. Episodes of blocked use warrant increased clinical attention, such as direct observation of naltrexone ingestion, increased dose, or increased intensity of treatment contact. Maintenance on oral naltrexone is a fragile treatment because it is so easily undermined by episodes of opioid use while non-compliant. New long-acting injectable or implantable formulations of naltrexone may address this limitation and should be investigated for treatment of opioid dependence.     

Management of acute pain in methadone maintenance therapy in-patients

Methadone maintained treatment (MMT) patients may be given less opioid analgesia for acute pain than the general patient, due to requests for analgesia being misinterpreted as craving for drugs. Pain studies have showed that MMT patients have hyperalgesic responses and that cross-tolerance to opioids may be present, suggesting that they may need more analgesia than the non-MMT patient. This study compares the pain management of MMT patients and controls during an acute hospital stay. It is a retrospective study of MMT in-patients and controls matched for medical condition, age and gender, comparing the analgesia given and pain stated in hospital notes. Patients with a chronic pain condition were excluded. MMT patients and controls did not differ in relation to median morphine dose received or average number of pain reports per day, and only a small proportion of both groups engaged in drug-seeking behaviour. Behavioural problems were significantly more common among MMT patients (39% versus 5%, p < 0.001). The fact that the opioid doses were not significantly different between subjects and controls seems to contradict the experimental evidence that patients on methadone tend to be hyperalgesic. Alternatively, MMT patients may be hyperalgesic, and statistically equal levels of opioid analgesia given to both groups may indicate an effective under-treatment of pain in the hyperalgesic MMT group. Inadequate analgesia may contribute to both behavioural problems and premature discharge. Resolving these uncertainties will require prospective studies.     

Developing histone deacetylase inhibitors in the therapeutic armamentarium of pancreatic adenocarcinoma

Introduction: Histone deacetylases (HDACs) are commonly dysregulated in pancreatic adenocarcinoma (PA) and have a central role in the development and progression of the disease. HDAC is a family of enzymes involved in deacetylation of lysine residues on histone and non-histone proteins. Deacetylation of histone proteins leads to compaction of the DNA/histone complex resulting in inhibition of gene expression. Deacetylation of non-histone proteins can affect the stability and function of key proteins leading to dysregulation of cellular signaling pathways. HDAC inhibitors have been shown to potentiate the antiproliferative and proapoptotic effects of several cytotoxic agents, in vitro and in vivo PA xenograft models. Areas covered: The areas covered include the biology and function of the HDAC isoenzymes and their significant role in multiple oncogenic pathways in PA. Preclinical and clinical trials evaluating HDAC inhibitors are also reviewed. Expert opinion: Despite discouraging early phase clinical trials evaluating HDAC inhibitors in PA, this strategy deserves further evaluation guided by better preclinical studies in identifying the role of specific HDAC isoenzyme inhibitors in PA. Evaluation of the effects of HDAC inhibitors on PA stem cell function and epithelial to mesenchymal transformation is also an evolving area that holds future potential for these agents. Such preclinical studies will yield insight into the functionality of HDAC isoenzymes, which can then be translated into rationally designed clinical trials. One such strategy could focus on HDAC inhibition employed in combination with proteasome inhibition targeting the aggresome pathway in PA.