化学药品注射剂的灭菌或无菌工艺现行要求及考虑

化学药品注射剂是临床上应用较广的一类无菌药品，鉴于其较高的安全性风险，确保注射剂的无菌性尤为关键。结合中国、美国和欧盟对注射剂的无菌保障监管及药品生产质量管理规范（GMP）指南的现行要求，进一步探讨化学药品注射剂的灭菌或无菌工艺控制。目前，我国化学药品注射剂的灭菌或无菌工艺选择要求与欧美国家基本一致，美国和欧盟对于湿热灭菌注射药品已实施参数放行。通过阐述注射剂灭菌或无菌工艺的评估及研究，为制药企业化学药品注射剂无菌保障控制策略及无菌风险管控的不断完善提供参考，以更好地提高注射剂的无菌保障。     

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers,patients and families

This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.     

基于Meta人种学的生命末期家庭照顾体验理论模型的研究

目的 系统整合中国家庭在患者生命末期的照顾体验，明确家庭照顾体验的核心元素，尝试构建诠释中国家庭照顾生命末期患者现象的理论模型。 方法 系统检索6个英文数据库和5个中文数据库中发表在2021年12月之前的描述中国家庭在患者生命末期的照顾体验的质性研究或混合型研究。采用Meta人种学方法对纳入的16篇文献进行整合。 结果 整合形成了8个核心元素，即爱与责任、临终意识、伴行、告别、五味杂陈、生活改变、个人成长和需求。其中7个核心元素的GRADE-CERQual整合质量评价的可信度为低至中度，1个核心元素的可信度为高度。论证整合显示，患者优逝是中国家庭照顾者临终照顾的最终目标。 结论 中国家庭对临终患者的照顾体验过程是动态的，对患者的爱和责任是中国家庭照顾者坚持的动力，家庭照顾者会因患者获得优逝而感到欣慰。     

Construction of a fused grid-based CYP2C19-Template system and the application

A ligand-accessible space in the CYP2C19 active site was reconstituted as a fused grid-based Template with the use of structural data of the ligands. An evaluation system of CYP2C19-mediated metabolism has been developed on Template with the introduction of the idea of Trigger-residue initiated ligand-movement and fastening. Reciprocal comparison of the data of simulation on Template with experimental results suggested a unified way of the interaction of CYP2C19 and its ligands through the simultaneous plural-contact with Rear-wall of Template. CYP2C19 was expected to have a room for ligands between vertically standing parallel walls termed Facial-wall and Rear-wall, which were separated by a distance corresponding to 1.5-Ring (grid) diameter size. The ligand sittings were stabilized through contacts with Facial-wall and the left-side borders of Template including specific Position 29 or Left-end after Trigger-residue initiated ligand-movement. Trigger-residue movement is suggested to force ligands to stay firmly in the active site and then to initiate CYP2C19 reactions. Simulation experiments for over 450 reactions of CYP2C19 ligands supported the system established.