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Leo Meunier Jossie A. Garthoff Anne Schaafsma Lisette Krul Jaap Schrijver Johannes B. van Goudoever Gerrit Speijers Yvan Vandenplas 《Regulatory toxicology and pharmacology : RTP》2014
Locust bean gum (LBG) is a galactomannan polysaccharide used as thickener in infant formulas with the therapeutic aim to treat uncomplicated gastroesophageal reflux (GER). Since its use in young infants below 12 weeks of age is not explicitly covered by the current scientific concept of the derivation of health based guidance values, the present integrated safety review aimed to compile all the relevant preclinical toxicological studies and to combine them with substantial evidence gathered from the clinical paediatric use as part of the weight of evidence supporting the safety in young infants below 12 weeks of age. LBG was demonstrated to have very low toxicity in preclinical studies mainly resulting from its indigestible nature leading to negligible systemic bioavailability and only possibly influencing tolerance. A standard therapeutic level of 0.5 g/100 mL in thickened infant formula is shown to confer a sufficiently protective Margin of Safety. LBG was not associated with any adverse toxic or nutritional effects in healthy term infants, while there are limited case-reports of possible adverse effects in preterms receiving the thickener inappropriately. Altogether, it can be concluded that LBG is safe for its intended therapeutic use in term-born infants to treat uncomplicated regurgitation from birth onwards. 相似文献
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Peter Asaad Adam O’Connor Shahab Hajibandeh Shahin Hajibandeh 《World journal of gastrointestinal endoscopy》2021,13(5):137-154
BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy, the outcomes of such procedure under regional anesthesia(RA) have been evaluated. In the context of cholecystectomy, combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA) in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included. The study populations in the RA and GA groups were of comparable age(P = 0.41),gender(P = 0.98) and body mass index(P = 0.24). The conversion rate from RA to GA was 2.3%. RA was associated with significantly less postoperative pain at 4 h [mean difference(MD):-2.22, P 0.00001], 8 h(MD:-1.53, P = 0.0006), 12 h(MD:-2.08, P 0.00001), and 24 h(MD:-0.90, P 0.00001) compared to GA. Moreover, it was associated with significantly lower rate of nausea and vomiting [risk ratio(RR): 0.40, P 0.0001]. However, RA significantly increased postoperative headaches(RR: 4.69, P = 0.03), and urinary retention(RR: 2.73, P = 0.03). The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes, with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA. However, its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy. 相似文献
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目的 了解基于顾客感知的不同层级医院服务质量满意度情况,为医院服务质量持续改进提供参考.方法 根据PZB的服务质量模型,从有形性、可靠性、响应性、保证性、移情性5个方面设计调查问卷,于2013年4月~8月对广东省某三级医院、某二级医院的顾客进行随机抽样调查.结果 顾客对三级医院、二级医院服务质量总体比较满意,但在某些方面仍有差距,尤其是二级医院.结论 医院应重视基于顾客感知的医疗服务质量满意度,积极改进不足,努力满足顾客合理需求,促医疗服务质量不断提高. 相似文献
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建立专科护士培训管理组织并明确职责,制定专科护士培训管理文件并严格执行,明确培训目标,确定专科护士分级,实施A、B、C三级专科护士培训,培训后落实动态考核并强化使用,提高了专科护士能力,稳定了专科护士队伍,促进了医院护理专科发展. 相似文献
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John D. Koerner Neeraj M. Patel Richard S. Yoon Mark J. Gage Derek J. Donegan Frank A. Liporace 《Injury》2014