A comparative study of plateletpheresis using Baxter Autopheresis C and Haemonetics PCS Plus

SUMMARY. This study compared plateletpheresis on the Haemonetics PCS Plus (PCS Plus) and the Baxter Autopheresis C (Auto C) using the same 100 selected donors. The number of packs meeting UK BTS/NIBSC specification (>2.2 times 10¹¹ platelets per pack) was achieved by 99% of PCS Plus and 82% of Auto C procedures. The positive correlation found between donor precount and final platelet yield was better for the PCS Plus. Both machines met U.K. specification for white-cell contamination but this was significantly greater for the Auto C. Plasma yields were similar.
As a result of this study we chose to use the PCS Plus for routine plateletpheresis in our unit. This has enabled us not only to comply with UK BTS/NIBSC specifications for apheresis platelets easily and cost effectively but also to meet our own higher specification (2.75 times 10¹¹ platelets per pack) using existing staff and without extending the working day.     

Quality of life on enalapril after acute myocardial infarction

Quality of life was assessed 4–6 months after an acutemyocardial infarction in a randomized double-blind study ofenalapril versus placebo. Quality of life was evaluated usingthe Nottingham Health Profile (NHP), the Physical Symptoms DistressIndex (PSDI), the Work Performance Scale (WPS) and the LifeSatisfaction Index (LSI). The study comprised 36 women (aged46–85 years, mean 68) and 96 males (aged 39–81 years,mean 62). Quality of life did not differ significantly between patientstreated with enalapril versus placebo. The scores were (enalaprilvs placebo, mean± SE): average NHP 15.4 ± 2.3vs 17.1 ± 2.3; PSDI 9.5± 1.0 vs 10.8 ±0.9; WPS 19.8 ± 2.0 vs 19.4 ± 1.4; LSI 24.1 ±1.0 vs 22.5 ±1.4. Men reported a better quality of lifethan women on most assessments, and non-smokers and ex-smokersbetter than smokers. Patients with moderate or severe anginapectoris had a worse quality of life measured by PSDI and NHPthan patients with minimal or no angina pectoris. Patients withcongestive heart failure had a higher PSDI than those without(13.6 ± 1.7 vs 9.4 ± 0.7, P<0.05), while nosignificant differences were observed in the NHP scores. In conclusion, quality of life was similar in enalapril andplacebo- treated patients after an acute myocardial infarction.However, it was reduced in patients with angina pectoris orheart failure and in those who continued smoking.     

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.     

Analysis of trauma intubations

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery. While mean revised trauma scores and Glasgow Coma Scale (GCS) scores differed for the groups, the mean length of hospital stay and the incidence of aspiration pneumonia were not significantly different. In the DELAYED group, 80% of those who developed aspiration pneumonia had a GCS < or = 13. Patients in the NONURGENT group were older and commonly presented with tachypnea. The survival rate for the NONURGENT group was lower than predicted by the TRISS method (P = .004). A GCS < or = 13 and age greater than 50 years with presenting respiratory rates of more than 25 breaths/min represent potential trauma intubation audit filters.     

腹腔镜胆囊切除术开展初期质量控制的临床研究

目的探讨如何控制腹腔镜胆囊切除术（LC）开展初期的并发症及中转率。方法制定八条质量控制措施，总结分析568例LC临床资料。结果并发症6例，仅占1．2％，中转手术8例，中转率仅1．6％。结论在开展LC初期只要加强质量控制，完全可以避开高并发症、高中转率这种所谓的自然规律。     

健康相关生命质量评价研究与应用现状

健康相关生命质量(HRQOL)是近年来发展起来的一种全新的医学概念,在国外已得到广泛的应用。着重介绍了健康相关生命质量的概况、研究与应用进展,阐述了健康相关生命质量的研究背景,以及新近发展的有关健康相关生命质量的观点和测评工具。对健康相关生命质量评价研究的前景和启示作了相关探讨。     

人胎盘提取组织凝血活酶及其质量评价

利用人胎盘抽提得组织凝血活酶，并对其质量进行了评价，同时初步应用于临床。结果显示：用含表面活性剂的抽提剂粉碎抽提的效果较好，所得组织凝血活酶重复性、灵敏度、稳定性均令人满意；与上海荣盛生物制品厂生产的ＰＴ试剂盒比较相关性好：Ｙ＝２．７５＋０．９０５ｘ，ｒ＝０．９２５３，经相关系数ｔ检验，ｔ＝２６．５４６９，Ｐ＜０．００１，呈直线正相关。临床初步应用显示：肝病及抗凝治疗等病人ＰＴ时间明显延长，９３例正常人ｘ＝１１．３秒，ｓ＝０．９６秒，正常范围９．４２－１３．１８秒。     

Health‐related quality of life in multiple system atrophy

Although multiple system atrophy (MSA) is a neurodegenerative disorder leading to progressive disability and decreased life expectancy, little is known about patients' own evaluation of their illness and factors associated with poor health‐related quality of life (Hr‐QoL). We, therefore, assessed Hr‐QoL and its determinants in MSA. The following scales were applied to 115 patients in the European MSA‐Study Group (EMSA‐SG) Natural History Study: Medical Outcome Study Short Form (SF‐36), EQ‐5D, Beck Depression Inventory (BDI), Mini‐Mental state examination (MMSE), Unified MSA Rating Scale (UMSARS), Hoehn & Yahr (H&Y) Parkinson's disease staging scale, Composite Autonomic Symptom Scale (COMPASS), and Parkinson's Disease Sleep Scale (PDSS). Forty‐six percent of patients had moderate to severe depression (BDI ≥ 17); Hr‐QoL scores on the SF‐36 and EQ‐5D were significantly impaired. Pain, the only domain with similar scores in MSA and published PD patients, was reported more frequently in patients with MSA‐P (predominantly parkinsonian motor subtype) than MSA‐C (predominantly cerebellar motor subtype; 76% vs. 50%; P = 0.005). Hr‐QoL scores correlated most strongly with UMSARS motor, COMPASS, and BDI scores but not with MMSE scores, age at onset, or disease duration. The COMPASS and UMSARS activities of daily living scores were moderate‐to‐strong predictors for the SF‐36 physical summary score and the BDI and UMSARS motor scores for the SF‐36 mental summary score. This report is the first study to show that Hr‐QoL is significantly impaired in MSA. Although not all possible factors related to impaired Hr‐QoL in MSA could be assessed, autonomic dysfunction, motor impairment, and depression were most closely associated with poor Hr‐QoL, and therapeutic management, therefore, should concentrate upon these aspects of the disease. © 2006 Movement Disorder Society     

运用现代教育理论思想 提高医学课堂教学质量

本文依据三种现代教育理论思想的有益启示,围绕医学高等专科学校课堂教学质量的提升问题,提出以加强教育理论思想研修为突破口,进而采取更新教育观念、狠抓移植应用和改进教法学法来有效提高医学高等专科学校课堂教学质量的新思路。