Human factors in obstetrics

The importance of human factors is becoming increasingly recognized in the healthcare profession. Lack of situational awareness, poor communication and inadequate leadership compounded by unfamiliar teams in a rapidly deteriorating clinical situation put obstetric patients at particular risk. There is much to be learnt from other high-risk industries including aviation and the military. Increasing awareness and training in human factors and utilization of communication tools (such as SBAR) and prompts (including emergency checklists) can help to promote a safer environment.     

蛋白酶抑制剂茚地那韦的知识产权保护状况和风险分析

通过对蛋白酶抑制剂茚地那韦国内外知识产权保护状况的初步分析,以及茚地那韦国际和国内的申请量、申请地区、申请人、保护状况和期限等方面统计,可见国外原研企业对于茚地那韦专利申请已逐年下降,但目前专利仍对该药有一定的保护力度,该药在合成方法、衍生物、新剂型、新用途等方面尚有较大的研发和保护空间,相关医药企业仍可从这些方面对该药进行研究改进或创新.     

TNF-α Blockade Efficiently Reduced Severe Intestinal Damage in Necrotizing Enterocolitis

Objectives: To ascertain the beneficial effects of infliximab an inhibitor of tumor necrosis factor alpha (TNF-α) on the development of NEC in an experimental NEC rat model. Material and Methods: Thirty newborn Sprague-Dawley rats were randomly divided into three groups as NEC, NEC+ infliximab, and control. NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia and cold stress. Pups in the NEC+ infliximab group were administered infliximab at a dose of 10 mg/kg daily by intraperitoneal route from the first day until the end of the study. All pups were sacrificed on the 5th day. Proximal colon and ileum were excised for histopathologic, immunohistochemical (TUNEL and caspase-3), and biochemical evaluation, including, total antioxidant status (TAS), total oxidant status (TOS), malonaldehyde (MDA), and myeloperoxdase (MPO) and TNF-α activities. Results: We observed better clinical sickness scores, weight gain, and survival rate in the NEC+ infliximab group compared to the NEC group (p < .05). Histopathological and apoptosis examination (TUNEL and immunohistochemical evaluation for caspase-3) revealed lower damage in the NEC+ infliximab group compared to the damage in the NEC group (p < .01). Tissue MDA, MPO, TNF-α levels, and TOS were significantly decreased in the NEC+infliximab group, whereas TAS was significantly increased in the NEC + infliximab group (p < .01). Conclusion: TNF-α blockade with infliximab efficiently reduced the intestinal injury and preserve the intestinal tissues from severe intestinal damage by its complex mechanisms on NEC. Therefore, it may be an alternative option for the treatment of NEC.     

X线机房内射线空间分布及合理利用的实验研究

目的：探讨 X 线机房内辐射场分布情况,为危重患者、陪护人员和需要进入机房施救的医务工作者提供科学的辐射防护依据。方法以 X 线管为中心,在摄影床水平面选择不同的点放置热释光剂量计(TLDs),改变 X 线摄影技术参数中的 X 线管电压值(kV)和照射野(FOV),选定不同的实验条件分组曝光,将受照射后的热释光剂量计送到实验室测量,所测数据均扣除本底。结果对每组实验数据中方位和距离2个变量进行单因素方差分析,P 值均<0.01,差异有统计学意义。相同 X 线摄影条件下,距离 X 线管中心越远,辐射剂量值越低,距离 X 线管中心越近辐射剂量值越高,10 cm 处的剂量值最高,距离 X 线管中心120 cm 处的剂量值最低;相同摄影条件和距离,辐射场剂量值在机房 X 线管阳极侧相对较低,辐射场剂量值在 X 线管后方相对较高;相同管电压值、相同距离和方位,FOV 为52.6 cm×52.6 cm 比 FOV 为34 cm×34 cm 条件下的辐射场剂量值较高;相同 FOV、相同距离和方位,120 kV 比70 kV 条件下的辐射场剂量值较高。结论X 线机房内医护及陪护人员的位置应尽量选择右侧方向(阳极),远离X 线管中心,避开 X 线管后方和阴极方向,可明显降低受照辐射剂量。     

Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID‐funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length‐for‐age z‐score (LAZ) decreased and weight‐for‐length z‐score (WLZ) increased from 6 to 12 months of age in both regions. One‐quarter of infants were stunted and nearly one‐third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P < 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy‐dense foods.     

Diagnosis and management of paediatric concussion

Heightened recognition of concussions and concerns about their sequelae in children has become an increasing community and public health concern. Biomarkers and clinical tests are being explored, but the diagnosis of concussion in the emergency department continues to be based on clinical signs and symptoms. While the majority of children go on to recover from post‐concussive symptoms within 2 weeks, it is unclear which patients with concussion will go on to develop short‐ or long‐term sequelae. A number of more or less evidence‐based guidelines have become available which seek to guide clinicians on how to manage children post‐concussion. In general, care after the emergency department is focused on reducing the risk of re‐injury and rest until cerebral recovery with a graduated return to school and then play.