Identification of HLA-A*0224: implications for PCR-SSP HLA typing

We describe a novel HLA-A*02 allele, A*0224, that was identified after a comparison of DNA and serological typing revealed a discrepancy in the HLA-A types: HLA-A2 was defined by serology but was not detected by the polymerase chain reaction using sequence-specific primers (PCR-SSP). DNA sequencing indicated the presence of a variant HLA-A*02 allele that differed from A*0201 by a single base (C/A) at position 453. This base substitution corresponded to the annealing site of a primer common to the two A*02-amplifying PCR-SSP mixtures used in the method. This provides an explanation for the results and highlights a limitation of PCR-SSP methods even where two PCR mixtures are used to detect alleles. Serological titration studies suggested that A*0201, A*0205 and A*0224 are unlikely to be differentiated during routine serological typing.     

Solubility in binary solvent systems: 8. Estimation of binary alkane plus p-dioxane solvent nonideality from measured anthracene solubilities

Experimental solubilities are reported for anthracene in binary solvent mixtures containing p-dioxane with n-hexane, cyclohexane, n-heptane, methylcyclohexane, n-octane, cyclooctane, and isooctane at 25 degrees C. Results of these measurements, used in conjunction with the nearly ideal binary solvent (NIBS) model, enabled excess Gibbs free energies, delta GBCfh, of the seven binary solvent mixtures to be estimated. Estimated values for p-dioxane plus cyclohexane, p-dioxane plus n-heptane, and p-dioxane plus methylcyclohexane mixtures are in reasonable agreement with published values based on vapor pressure measurements.     

Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse

BACKGROUND CONTEXTThe indication to perform a fusion and decompression surgery as opposed to decompression alone for lumbar degenerative spondylolisthesis (LDS) remains controversial. A variety of factors are considered when deciding on whether to fuse, including patient demographics, radiographic parameters, and symptom presentation. Likely surgeon preference has an important influence as well.PURPOSEThe aim of this study was to assess factors associated with the decision of a Canadian academic spine surgeon to perform a fusion for LDS.STUDY DESIGN/SETTINGThis study is a retrospective analysis of patients prospectively enrolled in a multicenter Canadian study that was designed to evaluate the assessment and surgical management of LDS.PATIENT SAMPLEInclusion criteria were patients with: radiographic evidence of LDS and neurogenic claudication or radicular pain, undergoing posterior decompression alone or posterior decompression and fusion, performed in one of seven, participating academic centers from 2015 to 2019.OUTCOME MEASURESPatient demographics, patient-rated outcome measures (Oswestry Disability Index [ODI], numberical rating scale back pain and leg pain, SF-12), and imaging parameters were recorded in the Canadian Spine Outcomes Research Network (CSORN) database. Surgeon factors were retrieved by survey of each participating surgeon and then linked to their specific patients within the database.METHODSUnivariate analysis was used to compare patient characteristics, imaging measures, and surgeon variables between those that had a fusion and those that had decompression alone. Multivariate backward logistic regression was used to identify the best combination of factors associated with the decision to perform a fusion.RESULTSThis study includes 241 consecutively enrolled patients receiving surgery from 11 surgeons at 7 sites. Patients that had a fusion were younger (65.3±8.3 vs. 68.6±9.7 years, p=.012), had worse ODI scores (45.9±14.7 vs. 40.2±13.5, p=.007), a smaller average disc height (6.1±2.7 vs. 8.0±7.3 mm, p=.005), were more likely to have grade II spondylolisthesis (31% vs. 14%, p=.008), facet distraction (34% vs. 60%, p=.034), and a nonlordotic disc angle (26% vs. 17%, p=.038). The rate of fusion varied by individual surgeon and practice location (p<.001, respectively). Surgeons that were fellowship trained in Canada more frequently fused than those who fellowship trained outside of Canada (76% vs. 57%, p=.027). Surgeons on salary fused more frequently than surgeons remunerated by fee-for-service (80% vs. 64%, p=.004). In the multivariate analysis the clinical factors associated with an increased odds of fusion were decreasing age, decreasing disc height, and increasing ODI score; the radiographic factors were grade II spondylolisthesis and neutral or kyphotic standing disc type; and the surgeon factors were fellowship location, renumeration type and practice region. The odds of having a fusion surgery was more than two times greater for patients with a grade II spondylolisthesis or neutral and/or kyphotic standing disc type (opposed to lordotic standing disc type). Patients whose surgeon completed their fellowship in Canada, or whose surgeon was salaried (opposed to fee-for-service), or whose surgeon practiced in western Canada had twice the odds of having fusion surgery.CONCLUSIONSThe decision to perform a fusion in addition to decompression for LDS is multifactorial. Although patient and radiographic parameters are important in the decision-making process, multiple surgeon factors are associated with the preference of a Canadian spine surgeon to perform a fusion for LDS. Future work is necessary to decrease treatment variability between surgeons and help facilitate the implementation of evidence-based decision making.     

对我国卫生资源配置和使用几个深层次问题的思索

我国卫生资源既贫乏又浪费已成为业内人士的共识,但又是一个困扰我国卫生事业发展的实际而又紧迫的问题,这个问题解决不好,就会人为无谓地降低我国卫生事业的公益性和福利性的“含金量”。,作者认为：要使我国有限的生效充分而合理利用,就要立足于我国的基本国情,在确保市场的微观调节的前提下,必须运用政府的宏观调控行为和政策指导手段,尽可能为管理体制的改革扫描障碍和给予法制保障。     

乳腺癌（改良）根治术住院流程与平均住院日

参照业务流程重组的理论与方法研究了乳腺癌根治术的住院流程。结果显示,该病种住院流程存在的主要问题有：诊疗服务的随意性过大,等待诊疗服务的时间过长,患者入院标准的掌握过松,对该病种往院注程进行重组,将在不影响医疗服务质量的前提下有效缩短平均住院日。     

临床知情同意准则确立的伦理和法律意义

由于临床医生忽视病人知情同意权而引起的医疗法律纠纷案不断增多,成为医院医疗和管理工作的一个新的关注点。维护病人在医疗中享有的知情同意权是临床医疗的基本准则;病人的这种自主权利受到道德的支持和现行法律的保护,提高医院和医生对医疗中知情同意的意识和相关问题的敏感性在未来的医疗和医患关系中显得越来越重要。     

儿童疾病单病种质量管理体系的研究

在总结分析武汉地区儿童疾病结构用度春诊疗规律的基础上,运用现代医院全面质量管理的理论,建立了以儿科常见病、多发 为主,兼纳部分专科疾病的２４个儿童疾病单病种质量控制标准及规范的组织管理和考核评价第统。形成以增强病种质量控制能力为核心的儿童疾病单病种质量管理体系。该管理体系运用后,医院医疗质量管理水平和社会、经济效益得到了同步提高,并了医务人员的医疗行为,使医院步入优质、低砂和高效的运营轨道。     

浅谈医院门诊部工作的主要特点与基本要求

翔实地阐述了门诊工作的特点：服务对象与病种的复杂性及心态的多样性;医疗质量监控缺乏系统必 ;病人就诊高峰的相对集中性;门诊诊治工作的时效性与风险性;急诊抢救工作的突发性与应性;门诊业务工作的多元性、专业性和服务保障工作的整体性;门诊部管理职能的双重性,同时提出了相应的基本要求。     

40所军队医院病种病例分型质量评价结果分析

应用病例分型质量费用监控管理软件和ＳＡＳ６．１２统计软件包,对４０所军队医院５０万份病例样本资料进行深入分析,结果显示：病例分型组合数据稳定,分析结果合理。