Observable tumours, risk assessment and experimental design

The first goal of this article is to outline a design for an efficient experiment for testing each of many chemicals for carcinogenic potential by dermal exposure, including a risk assessment when appropriate. The second is to validate a general mathematical model for the dose-response function in this situation by using the results from a large experiment in skin painting done by the Oak Ridge National Laboratory. These two goals are related because the general model is used as a guide in the choice of an efficient design for testing the many chemicals on which information is required.     

Recognition of and response to postpartum hemorrhage in rural northern India

This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.     

LAPAROSCOPIC CHOLECYSTECTOMY AND PREVIOUS ABDOMINAL SURGERY: A SAFE TECHNIQUE

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed. In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min. This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.     

Fluid management of hypernatraemic dehydration to prevent cerebral oedema: A retrospective case control study of 97 children in China

Aim: To compare the fluid management of hypernatraemic dehydration in acute gastroenteritis in those who developed cerebral oedema (cases) versus those who did not (controls). Methods: A retrospective study of 97 cases of hypernatraemic dehydration at a tertiary children's hospital in China over five years, in which rehydration regimes of 49 children who developed cerebral oedema were compared with 48 children who made an uneventful recovery. Results: Risk factors for cerebral oedema (vs. no cerebral oedema) were an initial fluid bolus (29/49 vs. 15/48, P = 0.006), the mean rate of bolus infusion (14.7 ± 2.2 vs. 10.8 ± 1.4 mL/kg/hr, P < 0.001), the severity of hypernatraemia (serum sodium 167.7 ± 7.8 vs. 161.3 ± 7.9 mmol/L, P < 0.001) and the overall rehydration rate (8.2 ± 1.1 vs. 6.4 ± 0.6 mL/kg/hr, P < 0.001). On logistic regression, a rapid rehydration rate was the most significant contributor to cerebral oedema. From receive operating characteristic (ROC) curve analysis, the safe rate of rehydration was <6.8 mL/kg/hr. Conclusion: The key risk factors for the development of cerebral oedema during recovery from hypernatraemic dehydration were too rapid a rate of rehydration, an initial fluid bolus to rapidly expand plasma volume and the severity of the hypernatraemia. Thus, we conclude that a uniformly slow rate of rehydration is the best way of preventing cerebral oedema.     

陕西省商洛市2009年至2011年1427例药品不良反应报告回顾分析

目的了解我市药品不良反应发生的特点和规律,促进合理用药水平,提高监测报告的质量。方法对我市2009年争2011年上报的1427例药品不良反应报告分别从患者的性别、年龄、给药途径、发生的原因、药品种类、临床表现等进行统计和分析。结果1427例药品不良反应报告中,医疗机构上报984例,药品零售店上报443例,药品生产企业报告数为零。抗感染药物引起的占47．93％,中成药及中药注射剂占22．56％;静脉给药引起占52．42％,口服药品占39．45％;临床表现以皮肤及附件损害最多占37．63％。结论加强和重视药品不良反应在涉药单位的监测,注意抗感染药物与中成药及中药注射剂的合理使用;选择适宜的给药方法,避免不良反应的重复发生。     

End-to-end electronic transfusion management in hospital practice

Background Errors occur at all stages of the hospital transfusion process and the resulting morbidity and mortality are well documented. Recent initiatives in the UK and elsewhere to reduce transfusion errors have focussed on implementing recommended manual procedures for good practice, but have only been partially effective. Aims Our approach was to ‘re-engineer’ bedside and laboratory transfusion procedures. Materials and Methods We implemented barcode patient identification, bedside handheld computers and electronically controlled blood fridges to simplify transfusion procedures and improve practice. Results There was an improvement from 11.8% to 100% of staff following the process for correct pre-transfusion bedside patient identification; no ABO incompatible red cell transfusions in 5 years; a reduction in wrong blood component transfused events from 1 in 27,523 to 1 in 67,935; reduced nursing (one nurse rather than 2 and half the time to administer blood) and laboratory workload; and more rapid delivery of urgently required red cell units to patients (from a median of 18 minutes to 45 seconds). The electronic system provided a simple mechanism for compliance with UK/EU regulatory requirements for the traceability of blood, and the documentation of transfusion and training. Feedback from both staff and patients was positive. Discussion The project was taken through pilot stages between 2001 and 2006 through to its full implementation across the acute hospitals in Oxfordshire in 2006/07. Our group wrote a national specification for the electronic transfusion process, but the implementation elsewhere in the UK has been slow. There is the potential to introduce an additional module into the electronic transfusion process to provide ‘decision support’ for doctors ordering blood to minimise inappropriate use of blood as part of a patient blood management programme, and use the same ‘end-to-end electronic’ approach for other clinical procedures such as drug administration. Conclusion The implementation of a hospital electronic transfusion management system was shown to provide improvement in transfusion practice and in the efficiency of the service.     

“围评价期”医院评价理论与实证研究

论述了＂围评价期＂医院评价理论之内涵,并对其在海南的实践过程进行归纳与总结;对应用该理论前后的医院评价效果进行定量和定性评估,结果表明该理论模式的应用对于医院管理尤其是对医疗质量持续改进与保障病人安全均具有较明显的功效;在此基础上,对我国新一轮医院评审工作提出若干建议。