Handoff strategies in settings with high consequences for failure: lessons for health care operations.

OBJECTIVE: To describe strategies employed during handoffs in four settings with high consequences for failure. DESIGN: ANALYSIS: of observational data for evidence of use of 21 handoff strategies. SETTING: NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto. MAIN MEASURE: Evidence of 21 handoff strategies from observations and interviews. RESULTS: Nineteen of 21 strategies were used in at least one domain, on at least an 'as needed' basis. CONCLUSIONS: An understanding of how handoffs are conducted in settings with high consequences for failure can jumpstart endeavors to modify handoffs to improve patient safety.     

American Cancer Society prostate cancer survivorship care guidelines

Answer questions and earn CME/CNE Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow‐up care to address the myriad of long‐term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow‐up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow‐up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long‐term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility‐specific and population databases. CA Cancer J Clin 2014;64:225–249. © 2014 American Cancer Society .     

Analgesic and anticonvulsant activity of new derivatives of 2-substituted 4-hydroxybutanamides in mice

Earlier in vitro studies of the compounds marked as GT27, GT28, GT29 and BM128 revealed their inhibitory action towards murine γ-aminobutyric acid (GABA) transporters (mGAT1-mGAT4). In the present paper, the pharmacological activity of four γ-hydroxybutyric acid (GHB) amide derivatives was investigated. The following procedures were involved: locomotor activity, hot plate and electroconvulsive threshold tests. The compounds' influence on motor coordination was evaluated in the chimney test, as well. Intraperitoneal (i.p.) administration of the GHB derivatives decreased animals' locomotor activity (ED(50) values ranged between 23.79 and 26.37 mg/kg). At a dose of 25 mg/kg (i.p.) the compounds prolonged the nociceptive reaction time latency in the hot plate assay to various degree and GT28 and GT29 were the most potent ones in this respect. Their analgesic efficacy was particularly pronounced 30 min after their administration [percent of maximal possible effect (%MPE) = 16.93 and 22.72, respectively]. The investigated GHB derivatives, except for GT29 at 100 mg/kg, increased the electroconvulsive threshold by approximately 4-11 mA as compared to the vehicle-treated mice. In the chimney test they impaired the animals' motor coordination to various degree. We suggest further investigations of the compounds to estimate their biological activity.     

Ala-Gln-Zn~(2+)配合物的主要理化及抗菌性质

以Ala-Gln二肽与ZnSO4反应,制备出Ala-Gln-Zn2+配合物溶液,透析除去SO42-、游离及不稳定结合的Zn2+,再冷冻干燥,获得Ala-Gln-Zn2+稳定配合物冻干粉,二肽与Zn2+的配位比(mol/mol)为2∶1。配合物羧酸羟基氢在3334.28cm-1的红外伸缩振动特征吸收消失,酰胺VN-H多重振动峰加强为在3334.28cm-1的单峰,1370 cm-1~1510 cm-1的酰胺(δNH+VCN)双重峰及在1100cm-1~1150cm-1区间的羰基强吸收双峰也明显增强。1H-核磁共振结果指出,配合物在12.57 ppm的羧酸羟基H信号消失,在3.74,4.55 ppm的化学位移比Ala-Gln二肽增加9.62%和24.49%,AFM呈现2分子二肽对1分子Zn2+的形貌。研究结果证明:2分子Ala-Gln二肽的C8羧基与Zn2+形成离子键,其羰基氧及C4酰胺平面上羰基氧分别提供孤对电子给Zn2+的空p轨道,形成配位键。配合物晶体呈球状,熔点183~184℃,logK4.46,抗羧肽酶A的水解率、对金黄色葡萄球菌及大肠杆菌的抑制能力分别比二肽高4.15、4.77和4.33倍。     

国家谈判药品门诊医保待遇现状、问题及完善措施

2017-2019年国家医保目录准入谈判有效缓解了高值创新药品的"看病贵"难题。但"重住院、轻门诊"医保现状使得谈判药品门诊实际报销水平较低,进而影响患者的健康福利。本文以97个谈判药品、337个统筹市为统计样本,实证分析门诊用药的医保报销情况,结果显示有40个品种在大部分统筹市(统筹市占比超过70%)的实际报销水平低于50%。进一步探究门诊待遇低的原因发现未纳入门诊特殊政策、或门诊特殊政策不完善是其主要原因。最后,本文基于国内各统筹市门诊补偿政策经验提出提高门诊保障待遇的建议与方案,认为各统筹市可通过实现门诊统筹、完善门诊特殊政策、探索创新支付等手段提高谈判药品门诊保障待遇,确保医保目录准入谈判结果落地工作的顺利实施。     

晚期早产与学龄前期儿童发育性运动协调障碍的相关研究

目的探讨晚期早产儿与学龄前期发生发育性运动协调障碍(developmental coordination disorder,DCD)的关系,为能进行有效干预提供依据。方法 2012年6-12月于江苏省苏南、苏中、苏北随机整群抽取5个城市25所幼儿园中6 811名3~6岁学龄前儿童,对儿童一般健康状况和出生史进行问卷调查,运用儿童运动成套评估工具第2版(Movement Assessment Battery for Children-Second Edition,MABC-2)对递交有效问卷的6 155名儿童进行运动协调能力测试,研究不良出生史对儿童运动协调能力发展的损伤。结果 6 147名儿童完成所有测试,晚期早产儿DCD及手灵巧度低下发生率与足月儿相比差异无统计学意义,但动静态平衡能力显著低于足月儿(P=0.014),目标抓握能力低于足月儿(P=0.051)。结论晚期早产可损伤儿童学龄前期动静态平衡和目标抓握能力,其原因可能与脑发育过程中不同部位损伤有关。     

医教协同培养儿童药物临床研究人才的探索与实践

目的 在药学专业型研究生培养中探索儿童药物临床研究人才的培养模式。方法 分析儿童药物临床研究者应具备的素质,构建系统化、多层次的医教协同培养机制,以应用为导向优化课程体系,以儿科药物治疗需求为驱动引导学位论文选题,加强培养过程监管。通过促进研究生角色和观念转换,进行儿童药物临床研究技术培训,促进成果转化,强化研究生儿童药物临床研究能力培养。结果 初步建成了基于医教协同理念的儿童药物临床研究人才培养模式,培养的研究生符合社会与行业需求。结论 构建医教协同培养机制是培养儿童药物临床研究人才的重要路径。     

腹腔镜Anderson-Hynes小儿肾盂输尿管成形的手术配合

目的总结腹腔镜辅助下小儿肾盂输尿管成形的手术配合经验。方法回顾分析32例肾积水患儿于腹腔镜下经结肠系膜入路行Anderson-Hynes肾盂输尿管成形术的手术配合资料。结果 32例患儿手术中医护配合默契,顺利完成手术。结论充分的术前准备,熟练的手术配合,仪器设备、器械的正确维护保养是手术顺利进行的保障。     

Analysis of Chlamydomonas thiamin metabolism in vivo reveals riboswitch plasticity

Thiamin (vitamin B₁) is an essential micronutrient needed as a cofactor for many central metabolic enzymes. Animals must have thiamin in their diet, whereas bacteria, fungi, and plants can biosynthesize it de novo from the condensation of a thiazole and a pyrimidine moiety. Although the routes to biosynthesize these two heterocycles are not conserved in different organisms, in all cases exogenous thiamin represses expression of one or more of the biosynthetic pathway genes. One important mechanism for this control is via thiamin-pyrophosphate (TPP) riboswitches, regions of the mRNA to which TPP can bind directly, thus facilitating fine-tuning to maintain homeostasis. However, there is little information on how modulation of riboswitches affects thiamin metabolism in vivo. Here we use the green alga, Chlamydomonas reinhardtii, which regulates both thiazole and pyrimidine biosynthesis with riboswitches in the THI4 (Thiamin 4) and THIC (Thiamin C) genes, respectively, to investigate this question. Our study reveals that regulation of thiamin metabolism is not the simple dogma of negative feedback control. Specifically, balancing the provision of both of the heterocycles of TPP appears to be an important requirement. Furthermore, we show that the Chlamydomonas THIC riboswitch is controlled by hydroxymethylpyrimidine pyrophosphate, as well as TPP, but with an identical alternative splicing mechanism. Similarly, the THI4 gene is responsive to thiazole. The study not only provides insight into the plasticity of the TPP riboswitches but also shows that their maintenance is likely to be a consequence of evolutionary need as a function of the organisms’ environment and the particular pathway used.