葡萄糖酸钙口服液预防机采血小板献血不良反应的临床研究

目的:分析在机采血小板献血者中应用葡萄糖酸钙口服液对献血不良反应的预防效果。方法:从2018年1月～2019年9月择取3000名机采血小板献血者,并随机予以分组研究。对照组1500名献血者采血过程中不进行任何处理,其中采1个治疗单位献血者800名,采2个治疗单位献血者700名;研究组1500名献血者采血过程中口服葡萄糖酸钙口服液,其中1个治疗单位献血者800名,采2个治疗单位献血者700名。对照分析两组献血不良反应情况。结果:研究组总献血不良反应发生率、采1个治疗单位献血者献血不良反应发生率、采2个治疗单位献血者献血不良反应发生率低于对照组(P0.05)。结论:对于机采血小板献血者来说,枸橼酸盐反应为主要献血不良反应,在采血之前使用葡萄糖酸钙口服液,可以有效避免献血不良反应出现,临床效果显著。     

基于精准招募策略的单采血小板献血人群特征及采供情况分析

目的 了解基于精准招募策略下顺德区中心血站(以下简称“本站”)单采血小板献血人群特征及采供情况,为进一步完善单采血小板献血者精准招募的长效机制提供科学依据。方法 选取2020年1月～2022年12月的620名新增单采血小板献血者和5446人次单采血小板捐献的献血者资料,以及单采血小板的采集总量、供应总量作为观察组;2017年1月～2019年12月的461名新增单采血小板献血者和4663人次单采血小板捐献的献血者资料,以及单采血小板的采集总量、供应总量作为对照组。对照组采用传统宣传招募方式进行招募,观察组在传统宣传招募方式的基础上引入精准招募策略进行招募。比较两组单采血小板献血者献血人次的特征(包括文化程度、职业、年龄、性别),新增单采血小板献血者的特征(包括职业、年龄、性别),单采血小板采集、供应情况(包括单采血小板采集总量、血小板供应总量、血小板采供比)。结果 两组单采血小板献血者献血人次的文化程度、职业、年龄比较,差异具有统计学意义(P<0.05);两组单采血小板献血者献血人次的性别比较,差异无统计学意义(P>0.05)。两组新增单采血小板献血者的职业、年龄、性别比较,...     

反复单采血小板对献血者健康的影响

回顾分析80例单采前后和60例反复单采血小板和血浆10次以上献血者的血细胞及血浆蛋白变化。使用CS-3000 Plus(Baxter)血细胞分离机,每次采集献血者血小板≥3.0×10~(11),悬浮于200ml血浆中,同时献血浆400ml,献血间隔为1个月。观察献血者单采血小板前后血细胞及血浆蛋白变化。80例单采血小板前后比较,献血者血小板计数下降30％(P<0.01),白细胞中的小细胞下降18％(P<0.01)。首次采血与10次以上单采血小板的血细胞无显著变化。单采后较其前,各项血浆蛋白指标均显著下降(P<0.01)。但10次以上单采血小板与首次相比,血浆蛋白各项指标均无显著差别。连续单采血小板1年以上,对献血者健康无影响,远期效果有待进一步观察。     

机器单采血小板的献血反应及其护理

目的：探讨机器单采血小板的献血反应及其护理中的注意事项。方法：早期发现单采血小板时献血反应的各种先兆症状,并做到对症用药及时处理。结果：本组有13例由于单采血小板时出现献血反应的献血者,通过及时准确的对症处理及必要的护理;在最短的时间内恢复常态。结论：机器单采血小板,对献血者来说是相对安全可靠的,通过主动、及时、有效的治疗和护理方法能够避免献血反应的发生。     

单采血小板献血者枸橼酸盐反应分析及对策

目的：分析单采血小板献血者发生枸橼酸盐反应与性别和循环量的关系。方法对2009年1月-2010年12月单采献血者1751名发生枸橼酸盐反应的情况进行分析,观察献血者的性别及循环血量和枸橼酸盐反应的关系。结果1751名献血者中,出现枸橼酸盐反应91例,其中女性枸橼酸盐反应最多为11%,中度反应发生率较高;男性枸橼酸盐反应为2%（P〈0.01）,多为轻度反应,循环量越多发生枸橼酸盐反应的比例越高（P〈0.01）。结论对发生枸橼酸盐反应的高发献血者采取有效的预防,减少献血反应的发生,使其成为捐献血小板的固定献血者,不断壮大无偿单采的献血队伍,满足临床对单采血小板的需求。     

首次单采血小板献血者的心理分析及护理

目的：分析首次单采血小板献血者的心理状态,并探究护理措施的效果。方法选择自2014年7月至2015年7月期间于我站首次单采血小板120位献血者作为研究对象,随机分为实验组和对照组,每组各60例,对照组实施常规护理,实验组在常规护理的基础上加用心理护理措施。观察比较两组献血者护理前后的心理状态。结果两组献血者组内比较,护理后献血者的心理状态显著优于护理前,差异显著,具有统计学意义（P＜0.05）;护理前两组献血者的心理状态评分,差异不明显（P>0.05）,不具有统计学意义;护理后两组献血者组间比较,观察组献血者的心理状态明显优于对照组献血者,具有统计学意义（P＜0.05）。结论对首次单采血小板献血者采取心理护理干预措施能够有效的改善献血者的心理状态,增加献血者的热情,可以在献血工作中推广应用。     

单采血小板献血者流失的影响因素及对策

目的 探讨影响单采血小板献血者流失的相关因素,并提出有建设性的血小板献血者保留对策。方法 基于肇庆市中心血站数据库管理系统,选取2014年1月至2018年12月肇庆市中心血站数据库中3073名单采血小板献血者作为研究对象进行回顾性分析。统计单采血小板献血者流失率情况,分析献血者流失影响因素。结果 在3073名调查对象中,献血者首次血小板捐赠后24个月内再次或多次参加血小板捐赠者1935名为对照组,仅捐赠一次者1138名为观察组,血小板献血者流失率为37.03%。单因素分析显示,两组的年龄、性别、自感身体健康状况、职业、文化程度、献血的认知程度、献血动机及献血体验感受比较,差异有统计学意义（P<0.05）。多因素分析显示,年龄、献血的认知程度、献血动机及献血体验感受是单采血小板献血者流失的影响因素（P<0.05）。结论 根据血小板献血者流失的原因及相关因素,有针对性制定血小板献血者保留策略,并提高献血服务质量,以达到减少血小板献血流失目的和提高新招募计划成功率。     

机采血小板献血反应的诱因分析及护理

目的预防和降低机采血小板献血者采集过程献血反应的发生,保证机采血小板质量。方法对434名机采血小板献血者中发生献血反应者的情况详细记录并进行分析。结果发生献血反应55例,占12．67％,其中轻度占9．67％、中度占2．30％、重度占0．07％。枸橼酸钠中毒发生献血反应21例,占4．79％;精神因素发生献血反应10例,占2．40％;身体因素发生献血反应19例,占4．42％;环境因素发生献血反应8例,占1．73％。PLT〈170×10^9／L,体质量50～55蚝的献血者、初次捐献血者和空腹、疲劳、睡眠不足的献血者易发生献血反应。结论选择体质量〉55kg,血小板计数高,可减少机采血小板献血者献血反应的发生。做好献血者健康教育和全程优质护理服务,是保证机采血小板质量的重要措施之一。     

心理护理对避免首次献血者出现献血反应的作用和影响

目的观察并探究心理护理干预对避免首次献血者发生献血反应的作用和影响。方法选取我站560例首次献血者为研究对象,采取随机对照的方法,将其分为两组,一组为对照组,行常规献血护理;另一组为观察组,应用心理护理干预。对两组献血者的献血反应情况进行对比与评价。结果经统计,观察组的献血反应发生率为2.14%,与对照组的5.71%相比发生明显下降,P<0.05,数据有统计学意义。结论通过对首次献血者展开献血全程心理护理干预,可有效缓解其紧张、恐惧等不良情绪,避免头晕目眩、恶心呕吐等献血反应的发生,充分促进我国献血事业的长远发展。     

优化成分献血微信电话综合预约招募模式的成效分析

目的 随着临床单采血小板成分血液应用水平极大提升,临床需求量应用量持续增长,由于单采血小板保存时间很短、采集需要时间长、临床需求易偏型的实际情况,成分献血者招募预约一直面临着现实的困难和挑战,因此献血者招募宣传工作的创新和探索非常重要。本研究分析临沂中心血站近年成分献血微信电话综合预约招募模式的应用,以利于引导动员更多更安全的献血者参与单采血小板的采集和捐献,进一步提升单采血小板成分血液采集水平。方法 回顾我站2018—2022年度成分献血者献血人次、献血量的增长变化数据,通过数据的对比对该策略总结分析,并对其成效进行评价。结果 2018—2022各年度成分献血量持续稳步较大幅度增长,2020年度成分献血量增长比率达到15.90%,成为历史高点;各年度成分献血不仅是献血量的显著增长,更是呈现了高质量的发展,安全的固定献血者占比持续大幅提升,2022年固定献血者人次占比达到97.64%,达到历史新高;成分献血服务工作对献血者保留成效明显,2022年献血者流失为0人次。结论 本站从2016年起,探索实施微信电话综合预约招募策略,取得了好的成效,切实保障了临床单采血小板成分血液的充足和安全供...     

Assessment of acyclovir intraindividual pharmacokinetic variability during continuous hemofiltration, continuous hemodiafiltration, and continuous hemodialysis.

The use of intravenous acyclovir can be particularly complicated in pediatric patients with evolving renal impairment, because of intraindividual pharmacokinetic variability linked to the patient's clinical condition. The objective of this study was to use therapeutic drug monitoring data to assess acyclovir intraindividual pharmacokinetic variability during several types of renal replacement therapy. Bayesian adaptive control of acyclovir dosage regimen was performed in a pediatric patient with bone marrow transplant who developed severe renal impairment. Acyclovir pharmacokinetic parameter values corresponding to the different techniques and periods of renal replacement therapy were estimated using USCPACK PC Clinical Programs and therapeutic drug monitoring data. Results showed a wide intraindividual pharmacokinetic variability during CAVH, CAVHDF, and CVVHD, reflecting not only the performance of each dialysis technique but also the difficulty in making use of each one. The acyclovir elimination rate constant was higher during CVVHD compared to CAVH or CAVHDF. Bayesian method appears to be valuable in assessing intraindividual pharmacokinetic variability, as it allows the clinician to deal with sparse routine patient data.     

Possibilities of continuous care

The continuity of health care in the Netherlands is hampered by its structure. There exists a sharp border between the first echelon in which the primary general care is given and the higher echelons in which the out-patient and hospital care is delivered. The policy of the Government is directed to substitution of out-patient and hospital functions, executed in primary care. The possibilities and difficulties for patients and pharmacists are discussed.     

A silicone pellet for continuous cocaine: comparison with continuous amphetamine

An inexpensive silicone pellet is described for the continuous administration of cocaine for up to 5 days. Rats implanted with this pellet show minimal skin irritation and go through distinct behavioral stages, with an initial period of hyperactivity followed by motor stereotypies. Then, at 3-4 days after implantation, a variety of hallucinogen-like ("late-stage") behaviors appear, including limb flicks, sudden startle responses, and repetitive mid-air grasping movements. Compared to continuous d-amphetamine, continuous cocaine induces decreased motor stereotypies but heightened "late-stage" behaviors.     

Evaluation of MPA and MPAG removal by continuous venovenous hemodiafiltration and continuous venovenous hemofiltration

The study assessed the removal of mycophenolic acid (MPA) and its major glucuronide metabolite (MPAG) during continuous venovenous hemofiltration (CVVHF) and continuous venovenous hemodiafiltration (CVVHDF) in 4 heart transplant recipients treated for at least 6 days with mycophenolate mofetil (MMF) in addition to cyclosporine and corticosteroids. The sieving coefficient ranged from 0.02 to 0.04 for MPA and from 0.15 to 0.33 for MPAG. The clearance of MPAG by CVVHDF or CVVHF ranged from 7.52 mL/min to 19.45 mL/min, and that of MPA was lower than 2.28 mL/min, with no significant difference between the two continuous replacement therapies. Whereas MPA percentage recovered by hour following CVVHDF or CVVHF was negligible, the percentage of MPAG represents up to 12.9% of the administered dose. A relevant decrease in the free fraction of MPA and MPAG was observed after continuous renal replacement therapy (CRRT). These preliminary results demonstrate that MPAG is able to permeate the filter. In light of the alteration in protein binding following CRRT and the competition between MPA and MPAG to albumin site, drug monitoring of MPA and MPAG in patients undergoing CVVHDF or CVVHF may be suggested. Moreover, monitoring of free MPA may be of interest for these patients.     

Modeling and simulation of continuous powder blending applied to a continuous direct compression process

Abstract

Continuous manufacturing techniques are increasingly being adopted in the pharmaceutical industry and powder blending is a key operation for solid-dosage tablets. A modeling methodology involving axial and radial tanks-in-series flowsheet models is developed to describe the residence time distribution (RTD) and blend uniformity of a commercial powder blending system. Process data for a six-component formulation processed in a continuous direct compression line (GEA Pharma Systems) is used to test the methodology. Impulse tests were used to generate experimental RTDs which are used along with parameter estimation to determine the number of axial tanks in the flowsheet. The weighted residual from the parameter estimation was less than the χ² value at a 95% confidence indicating a good fit between the model and measured data. In-silico impulse tests showed the tanks-in-series modeling methodology could successfully describe the RTD behavior of the blenders along with blend uniformity through the use of radial tanks. The simulation output for both impulse weight percentage and blend uniformity were within the experimentally observed variance.     

Pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration and continuous venovenous hemofiltration in critically ill patients

STUDY OBJECTIVE: To assess the pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration (CVVHDF) and continuous venovenous hemofiltration (CVVH). DESIGN: Nonrandomized pharmacokinetic evaluation. SETTING: University surgical intensive care unit. PATIENTS: Six critically ill patients. INTERVENTION: Five patients received levofloxacin 500 mg/day and one patient received levofloxacin 125 mg/day All patients received continuous renal replacement therapy: CVVHDF on day 1 and CVVH on day 2, using an acrylonitrile hollow-fiber 0.9-m2 filter, constant blood flow rate of 90 ml/minute, substitution flow rate of 1 L/hour predilution, and dialysate flow rate of 1 L/hour (CVVHDF). MEASUREMENTS AND MAIN RESULTS: Serum, ultrafiltrate, and dialysate concentrations of levofloxacin were determined by high-performance liquid chromatography. Extracorporeal clearance was 26.05 +/- 4.66 ml/hour during CVVHDF and 15.71 +/- 2.73 ml/hour during CVVH (p<0.05). Elimination half-life was 28.08 +/- 4.5 hours and 45.9 +/- 17.7 hours, and distribution volume was 1.51 +/- 0.52 L/kg and 1.42 +/- 0.42 L/kg for CVVHDF and CVVH, respectively. Saturation was 0.76 +/- 0.13 for CVVHDF versus a sieving coefficient of 0.77 +/- 0.16 for CVVH. CONCLUSION: Marked extracorporeal elimination of levofloxacin occurs, requiring a dosage adjustment that can be calculated from the characteristics of CVVH and CVVHDF.     

Clinical pharmacology of continuous infusion doxorubicin

Fifteen patients were studied during short-term (5 days at 10-15 mg/m2/day) or long-term (5-104 days at 3 mg/m2/day) doxorubicin infusion. Levels of doxorubicin and metabolites in serum and 24-h timed urine collections were determined by high-performance liquid chromatography. Quantifiable anthracycline levels were identified in serum of 5 of 6 patients (6 courses) receiving drug at 10 mg/m2/day. In 5 courses, total anthracycline levels were 10-80 ng/ml, whereas levels as high as 370 ng/ml were observed in a patient with hepatorenal failure. No detectable serum levels of anthracycline were seen in patients receiving long-term doxorubicin therapy. Although analysis of 24-h timed urine collections revealed that doxorubicin was the predominant anthracycline, the extent of urinary elimination showed considerable interpatient variation (1.0-52.5% of the infused dose/24-h period on the short-term protocol and 5.3-57.2%/24-h period on the long-term protocol). Metabolic processing of doxorubicin administered by continuous infusion was found to be similar to that of drug given by bolus administration and showed no change in pattern with time. However, a greater variability in serum and urinary anthracycline levels was seen among patients on infusion schedules than has been noted with bolus drug treatment.     

Dose-response modeling of continuous endpoints.

A family of (nested) dose-response models is introduced herein that can be used for describing the change in any continuous endpoint as a function of dose. A member from this family of models may be selected using the likelihood ratio test as a criterion, to prevent overparameterization. The proposed methodology provides for a formal approach of model selection, and a transparent way of assessing the benchmark dose. Apart from a number of natural constraints, the model expressions follow from an obvious way of quantifying differences in sensitivity between populations. As a consequence, dose-response data that relate to both sexes can be efficiently analyzed by incorporating the data from both sexes in the same analysis, even if the sexes are not equally sensitive to the compound studied. The idea of differences in sensitivity is closely related to the assessment factors used in risk assessment. Thus, the models are directly applicable to estimating such factors, if data concerning populations to be compared are available. Such information is valuable for further validation or adjustment of default assessment factors, as well as for informing distributional assessment factors in a probabilistic risk assessment. The various applications of the proposed methodology are illustrated by real data sets.