基于RCA2的一例下肢PICC置管穿刺鞘断裂事件持续改进

目的了解下肢PICC置管穿刺鞘断裂不良事件的根本原因并进行系统改进。方法成立专家团队,根据RCA2实施步骤进行事件调查,识别近端原因,采用质量检测、资料比对和问题树分析法等寻找根本原因,从建立风险评估管理体系、完善标准操作程序、建立床旁超声急会诊分级管理机制三方面进行改进。结果PICC导管选择符合率由75.51%提升至100.00%,穿刺鞘使用规范率由82.65%提升至96.26%,一次性置管成功率由95.92%提升至100.00%;紧急床旁超声到位时间从平均26 min缩短至14 min,床旁超声急会诊到位时间达标率由33.33%提升至100.00%。未再出现断鞘事件。结论应用RCA2寻找不良事件系统根因并进行改进,有利于强化事前风险管理,增强团队合作,建立组织质量安全文化,从而保障患者安全。     

Effect of Hepatitis E Virus RNA Universal Blood Donor Screening,Catalonia, Spain, 2017‒2020

Hepatitis E virus (HEV) is the major cause of acute viral hepatitis in several countries in Europe. HEV is acquired mainly by consumption of contaminated pork but can also be transmitted through blood transfusion. HEV infection is usually self-limited but can become persistent in immunocompromised persons. During the first 30 months of HEV RNA universal screening of blood donations in Catalonia, Spain, we identified 151 HEV RNA–positive donations (1/4,341 blood donations). Most infected donors reported consumption of pates and sausages, and 58% were negative for HEV IgM and IgG. All HEV isolates belonged to genotype 3. All infected donors spontaneously resolved the infection, and no neurologic symptoms and reinfections were observed after 1 year of follow-up. Since the implementation of HEV RNA universal screening, no new cases of transfusion-transmitted HEV infection were reported. Our data indicate HEV screening of blood donations provides safer blood for all recipients, especially for immunosuppressed persons.     

颅内压监测仪联合软通道穿刺引流术治疗高血压脑出血的疗效及对内皮素-1和基质金属蛋白酶-9的影响

目的:探讨颅内压监测联合软通道穿刺引流术治疗高血压脑出血(HICH)的疗效及对内皮素-1(ET-1)和基质金属蛋白酶-9(MMP-9)的影响。方法:选取医院神经外科收治的75例HICH患者,依据治疗方法的不同将其分为观察组(39例)和对照组(36例),观察组行颅内压监测联合软通道穿刺引流术治疗,对照组行常规软通道穿刺引流术治疗。比较两组初始血肿量、术中抽吸血肿量、抽吸血肿量体积比及术后血肿排空时间,检测血清ET-1、MMP-9及晚期氧化蛋白产物(AOPP)水平,比较两组术后住院期间并发症发生率。结果:两组术中初始血肿量比较差异无统计学意义;观察组术中抽吸血肿量、血肿量体积比和血肿排空时间均少于对照组,差异有统计学意义(t=6.221,t=24.421,t=4.247;P<0.05);观察组术后7 d血清ET-1、MMP-9和AOPP均低于对照组,差异有统计学意义(t=8.826,t=10.954,t=14.204;P<0.05);观察组患者术后住院期间再出血、继发性颅内感染和头皮渗液的并发症发生率占比分别为10.26%,2.56%和10.26%,均低于对照组的36.11%,13.29%和33.33%,差异有统计学意义(x²=7.139,x²=4.400,x²=5.940;P<0.05);观察组和对照组的预后良好率分别为56.41%和33.33%,差异有统计学意义(x²=4.023,P<0.05)。结论:颅内压监测联合软通道穿刺引流术治疗HICH,能有效降低颅内压至目标值,清除血肿,下调血清ET-1、MMP-9及AOPP水平,减少术后住院期间并发症,可改善预后。     

Perceived Treatment Need and Latent Transitions in Heroin and Methamphetamine Polydrug Use among People who Inject Drugs in Tijuana,Mexico

People who inject drugs (PWID) in Tijuana, Mexico, use heroin and/or methamphetamine. While polydrug use is associated with HIV risk behavior, less is known about the stability of polydrug use patterns over time and how polydrug use is related to perceived treatment need. Within a cohort of PWID in Tijuana (N = 735) we sought to (1) characterize subgroups of polydrug and polyroute use from baseline to six months; (2) determine the probabilities of transitioning between subgroups; and (3) examine whether self-reported need for help for drug use modified these transition probabilities. Latent transition analysis (LTA) identified four latent statuses: heroin-only injection (38% at both baseline and follow-up); co-injection of heroin with methamphetamine (3% baseline, 15% follow-up); injection of heroin and methamphetamine (37% baseline, 32% follow-up); and polydrug and polyroute users who injected heroin and both smoked and injected methamphetamine (22% baseline, 14% follow-up). Heroin-only injectors had the highest probability of remaining in the same latent status at follow-up. The majority reported great or urgent need for treatment (51%) and these PWID had greater odds of transitioning to a higher-risk status at follow-up, emphasizing the need for evidence-based drug treatment options for PWID.     

新疆维吾尔自治区伊犁哈萨克自治州艾滋病报告病例传播途径误报及其影响因素分析

目的 对新疆维吾尔自治区(新疆)伊犁哈萨克自治(伊犁)州艾滋病报告病例的传播途径进行系统的整理及校正,为艾滋病防治资源的投入与分配提供依据。方法 对伊犁州2011-2014年报告的HIV感染者通过访谈开展传播途径现场核查并详细了解传播途径误报者误报原因。结果 调查对象总体误报率为10.8%,异性传播途径构成由63.8%被高估为72.0%,注射吸毒途径构成由27.5%被低估为22.2%。异性传播途径误报人数远高于其他途径,占82.6%。误报者主要经异性传播流向注射吸毒及其他,占误报总人数的79.5%。logistic多因素分析结果显示:男性误报风险为女性的3.64倍;无预期检测者误报风险为有预期检测者的2.23倍;年龄越高误报风险越高,与≤16岁者比较,17～30岁、31～45岁、46～60岁和60岁以上年龄组的误报风险依次为3.511、4.053、4.415和6.524倍。结论 新疆伊犁州艾滋病报告病例传播途径构成中,异性传播被高估,注射吸毒被低估,但总体趋势已由以往的注射吸毒传播为主转为异性传播为主。建议对男性、无预期检测者和高龄者进行首次随访时投入更多的关注。     

失效模式与效应分析对CT定位肺穿刺活检穿刺成功率及穿刺损伤的影响

目的 探讨失效模式与效应分析(FMEA)对CT定位肺穿刺活检穿刺成功率及穿刺损伤的影响.方法 回顾性分析2018年2月至2020年2月于我院行CT定位肺穿刺活检的1 600例患者的临床资料,观察组(800例)采用FMEA管理,对照组(800例)采用常规管理.比较两组CT定位肺穿刺活检穿刺成功率及穿刺损伤发生情况.结果 ...     

经直肠超声引导在前列腺13点法穿刺活检中的临床应用价值

目的探讨直肠超声引导在前列腺13点法穿刺活检术中的临床应用价值,提高诊断阳性率。方法对108例具有前列腺穿刺指征患者行超声引导下前列腺穿刺术,并分析临床资料。结果 108例患者均取材成功,成功率为100%。病理结果显示前列腺癌60例(55.56%)和良性前列腺增生48例(44.44%)。术后肛门滴血6例、尿道出血2例,无严重并发症发生。65例经直肠超声检查发现前列腺结节者,诊断与病理符合率为83.08%;43例未检出结节,符合率为51.16%,差异存在统计学意义(P<0.05)。穿刺前超声检查发现结节者,超声诊断灵敏度为89.36%,显著高于无结节者的30.77%,差异有统计学意义(P<0.05);但二者特异度相似,差异无统计学意义(P>0.05)。随着前列腺癌病理分级的升高,其血清中PSA浓度也相应升高,呈正相关(P<0.05)。结论经直肠超声引导下行前列腺13点穿刺活检术,穿刺成功率高、术后并发症少、有助于前列腺疾病的定性诊断,值得临床推广应用。     

Demographic and Clinical Features of Chinese Heroin Users Who Switch from Non-injection to Injection

Background: Injection drug users (IDUs) are at high-risk for acquiring human immunodeficiency virus, hepatitis C virus, and other infections, and delaying the switch from non-injection drug use to injection to drug use could reduce the spread of these infections. Objectives: To estimate the incidence of switching from non-injected heroin use (usually smoking or “chasing”) to injection and to investigate the risk factors for this change. Methods: We reviewed the socio-demographic and clinical data of 7305 heroin-dependent patients treated at a detoxification clinic of a university-affiliated psychiatric hospital in China from January 2000 to February 2009. Results: Within 1 year, the majority of non-injection drug users (NIDUs) transitioned to IDUs (59.4% within 6 months and 76.7% within 12 months). Multiple logistic regression analysis showed that marital status, years of education, employment status, age at onset of heroin use, duration of drug abuse, and initial dose were associated with the switch from NIDU to IDU. Being married (B = ?0.410, OR = 0.664), being employed (B = ?0.243, OR = 0.784), and older age at onset (B = ?0.040, OR = 0.961) were protective factors. More education (B = 0.120, OR = 1.128), longer duration of drug abuse (B = 0.010, OR = 1.010), and a higher dose at initial drug use (B = 0.234, OR = 1.264) were risk factors. Conclusions/Importance: The study has identified several risk factors for the switch to injection among heroin users. Understanding these factors can help design new approaches to more specifically target high-risk populations and high-risk behaviors to delay or prevent the transition to injection.     

Enhancing Immunogenicity and Reducing Dose of Microparticulated Synthetic Vaccines: Single Intradermal Administration

PURPOSE: Our purpose was to evaluate the ability of a polymeric vehicle to release a model synthetic vaccine to the skin in order to reach a potent activation of the specific immune response. METHODS: The peptide-loaded poly-D,L-lactide-co-glycolide acid (PLGA) microparticles were prepared by a double emulsion technique and administered to Balb/c mice. The immune response (antibody and T cell activation) obtained by the intradermal (i.d.) and the subcutaneous (s.c.) routes was tested. RESULTS: When similar doses of peptide-loaded microparticles were injected s.c. or i.d. in mice, the antipeptide IgG antibody immune response was found to be significantly higher after i.d. injection into the skin. We could also reduce the dose of antigen 10 times by the i.d. route and find a similar antibody response to that obtained by the s.c. immunization. At the lowest i.d. dose level, the IgG2a/IgG1 ratio was also incremented and the IgE production decreased. The i.d. microparticles induced, at both dose levels, a marked IFN-gamma secretion by peptide-stimulated splenocytes and lymph node cells and a significant T cell proliferation in spleen cell cultures. CONCLUSIONS: The results demonstrate that peptide-loaded microparticles were efficiently administered by the i.d. route because lower doses were required and powerful antibody and T cell responses were obtained compared to the conventional s.c. administration.     

Heroin is More Than Just Diamorphine

Heroin isn't just heroin anymore. Over the last two decades, there has been diversification in the forms and ‘brands’ of heroin which exist in both the domestic as well as international marketplaces. Closer examination reveals important differences between these ‘brands’. Black market heroin may now be obtained in either the form of salt (hydrochloride) or the separated base. Importantly, the different forms have different suitabilities for use by injection or by ‘chasing the dragon’, with the salt form being most suitable for injecting, whilst many of the base forms are either used by ‘chasing’ or are chemically transformed to the salt before injection. Country of origin and obvious physical characteristics such as colour are strong predictors of ‘salt’ or ‘base’ status. When consideration is given to the more recent technique of chasing the dragon, a new interpretation can be attached to some of the other drugs found in samples of black market heroin (often described as ‘impurities’). New data have identified that several of these additional drugs increase substantially the proportion of heroin which sublimates and can successfully be recovered by the heroin ‘chaser’, and these increases can be seen in the extent of recovery of both salt and base forms of heroin. Finally, new policy options are explored in the light of this new evidence-options that include the proposed development and promotion of NIROAs (non-injectable routes of administration), and the possible constructive manipulation of the heroin marketplace through differential application of interdiction efforts so as to promote the move from injecting to ‘chasing’ as the chosen method of heroin use.