PATIENT ACCIDENTS IN HOSPITAL: INCIDENCE,DOCUMENTATION AND SIGNIFICANCE

SUMMARY Many previous studies of reported patient accidents in hospital used the accident report forms as the only data source, without questioning their reliability and despite 80% of the accidents being unwitnessed. This paper reports on three studies using data from patient interviews, staff questionnaires, medical and nursing notes and the accident report forms. The studies confirm that falls amongst elderly patients are the most common type of patient accident. However, patients' and staff's versions of the event often differed widely. Accident reports are stated to be required for legal purposes, but they were often incomplete and unreliable. Patient accidents and safety are too important to remain marginalised to mere compliance with out-of-date regulations. A new, ‘slim-line‘, more accurate but less time-consuming patient accident reporting system should be developed, for which improvement in patient safety is the main aim and legal considerations the secondary aim.     

癫痫患者全夜自然睡眠结构的研究

目的　观察癫痫患者发作间期全夜自然睡眠结构特点 ,并评价其与正常对照组睡眠结构的差异 ;评价发作类型、用药情况及是否记录到发作间电发放对睡眠结构的影响。方法　对 2 0名癫痫患者及 11名对照进行全夜自然睡眠多导监测 ,并结合患者的发作类型、是否记录到发作间电发放 (IIDs)及服用 AEDs的情况进行分组统计分析 ,评价各组患者与正常对照间各睡眠参数的差异。结果　癫痫患者组 ,记录到 IIDs组 ,及该组患者中部分性发作者和未服 AEDs者均较正常对照 TRT、RL 显著延长 (P<0 .0 5)。记录到 IIDs的患者睡眠效率显著下降 (P≤0 .0 5) ,其中部分性发作者入睡后觉醒次数较全身性发作者显著增多 (P<0 .0 5)。部分性发作者较全身性发作者NREM睡眠期转换次数有增高的趋势。不同用药癫痫患者睡眠脑电图较正常对照组睡眠破碎性增加。结论　癫痫患者与正常对照比较 RL延长 ;睡眠破碎性增加 ;记录到 IIDs的患者睡眠效率降低 ;部分性发作患者较全身性发作患者有 NREM期转换次数频繁的趋势 ;记录到 IIDs患者中服用 AEDs的情况对其睡眠结构无显著影响。     

机器人辅助腹腔镜下根治性膀胱切除加尿流改道术的临床分析

目的 探讨采用da Vinci S机器人系统完成机器人辅助腹腔镜下根治性膀胱切除(robotic-assisted laparoscopic radical cystectomy,RARC)加尿流改道术的临床可行性,并总结技术特点和临床效果. 方法 2007年12月至2012年3月膀胱尿路上皮癌患者22例,男20例,女2例.年龄37～ 72岁,平均62岁.体质指数22.5 ～ 30.1 kg/m2,平均26.1 kg/m2.麻醉评分1～2分.术前肿瘤活检病理诊断为浸润性或高危的非肌层浸润性膀胱尿路上皮痛,术前检查均未发现有其他邻近脏器浸润、盆腔淋巴结转移或远处转移,临床分期均低于T2N0M0.全麻下行RARC加尿流改道术,其中行体外尿流改道术15例(原位新膀胱2例,回肠膀胱术13例),行完全腹腔镜下尿流改道术7例(回肠膀胱术2例,原位新膀胱5例). 结果 本组22例手术均获得成功.手术时间300 ～ 667 min,平均480 min;出血量100 ～ 1200 ml,平均550 ml;淋巴结清扫数目6～ 25枚,平均15枚.术后2～3d下地活动,3～4d肠功能恢复,术后住院时间8～35 d,平均16d.行原位新膀胱的患者术后1个月行膀胱造影确定无吻合口漏后拔除尿管和双侧输尿管支架管.术后随访4 ～ 49个月,平均32个月,复发2例,死亡1例,出现肾积水2例,其余病例肾功能均正常,尿控较满意. 结论 根据初期的手术操作过程和随访结果,RARC加尿流改道术在临床上是可行的.更多的操作经验、长期和随机的对照研究将有助于对这一技术进行评估和推广.     

Amifostine (WR-2721) shortens the engraftment period of 4- hydroperoxycyclophosphamide-purged bone marrow in breast cancer patients receiving high-dose chemotherapy with autologous bone marrow support

4-Hydroperoxycyclophosphamide (4-HC), a commonly used marrow-purging agent, is active against many tumors, but is also toxic to normal marrow progenitors. Amifostine (WR-2721) is a sulfhydryl compound with chemoprotectant activity. Preclinical studies using suspensions of bone marrow and breast cancer cells demonstrated that ex vivo treatment with amifostine followed by 4-HC resulted in protection of marrow progenitors, with no compromise in the antitumor effect of 4-HC. This fact stimulated the development of a clinical trial. Bone marrow was harvested from 15 poor-prognosis breast cancer patients and randomly assigned to ex vivo treatment with amifostine followed by 4-HC (amifostine + 4-HC), or treatment with 4-HC alone. High-dose chemotherapy was then administered followed by infusion of the purged autologous bone marrow support (ABMS). Leukocyte engraftment, defined as a white blood cell count > or = 1 x 10(9)/L, was achieved in an average of 26 days for patients whose marrow was purged with amifostine + 4-HC versus 36 days for patients whose marrow was purged with 4-HC alone (P = .032). The average number of platelet transfusions (12 v 29; P = .017) and days of antibiotic therapy (28 v 40; P = .012) were significantly less for patients whose marrow was exposed to amifostine + 4-HC, compared with 4-HC alone. Unpurged backup marrow fractions were infused into three patients whose marrow was purged with 4-HC alone, because of inadequate marrow recovery. None of the patients who received amifostine + 4-HC-purged marrow required a backup marrow fraction. Complete remissions were achieved in 83% of patients with measurable disease, with no difference between the two cohorts. Forty- three percent of patients remained alive and progression-free at a mean of 13 months posttransplant. There was no significant difference in the rate or pattern of relapse for patients whose marrow was purged with amifostine + 4-HC compared with those whose marrow was purged with 4-HC alone. Ex vivo treatment of marrow with amifostine significantly shortens the time to marrow recovery, thereby reducing the risk of myelosuppressive complications in breast cancer patients receiving high- dose chemotherapy and 4-HC-purged ABMS. Since supportive care requirements are also significantly decreased, amifostine may reduce the cost of such therapy.     

社会主义核心价值体系融入医学生医德教育的伦理诉求

医德修养和医德品质是医务人员必备的思想品质,是和谐医患关系的道德前提。以社会主义核心价值体系为指导,把社会主义核心价值体系融入医德教育中,是帮助医学生树立崇高的医德理想、明确医德追求、继承医德传统、锤炼医德品质和提升医德修养的重要途径和方法。     

Inactivation of factor XIa in human plasma assessed by measuring factor XIa-protease inhibitor complexes: major role for C1-inhibitor

From experiments with purified proteins, it has been concluded that factor XIa (FXIa) is inhibited in plasma mainly by alpha 1-antitrypsin (a1AT), followed by antithrombin III (ATIII), C1-inhibitor (C1Inh), and alpha 2-antiplasmin (a2AP). However, the validity of this concept has never been studied in plasma. We established the relative contribution of different inhibitors to the inactivation of FXIa in human plasma, using enzyme-linked immunosorbent assays (ELISAs) for the quantification of complexes of FXIa with a1AT, C1Inh, a2AP, and ATIII. We found that 47% of FXIa added to plasma formed complexes with C1Inh, 24.5% with a2AP, 23.5% with a1AT, and 5% with ATIII. The distribution of FXIa between these inhibitors in plasma was independent of whether FXIa was added to plasma, or was activated endogenously by kaolin, celite, or glass. However, in the presence of heparin (1 or 50 U/mL), C1Inh appeared to be the major inhibitor of FXIa, followed by ATIII. Furthermore, at lower temperatures, less FXIa-C1Inh and FXIa-a1AT complexes but more FXIa-a2AP complexes were formed. These data demonstrate that the contribution of the different inhibitors to inactivation of FXIa in plasma may vary, but C1Inh is the principal inhibitor under most conditions.