Adverse drug events in hospitalized patients A comparison of doctors, nurses and patients as sources of reports

Objective: This study investigated the relative value of adverse drug events reported by doctors, nurses and patients. Methods: The study was conducted on a total of four wards: the paediatric and internal medicine wards (including geriatric patients) of two peripheral hospitals in the Netherlands. Adverse drug events were collected by spontaneous reporting (doctor and nurse reports) and by daily ward visits, during which the patients were interviewed by a hospital pharmacist (patient reports). Criteria for relative value of the reported adverse drug events were the number of potentially serious reactions, the number of reactions not mentioned in the patient information leaflet and the number of reactions reported to new drugs (5 years or less on the Dutch market). No formal causality assessment was applied. Results: Over a period of 2 months in 1996 (Hospital I) and 2 months in 1997 (Hospital II) a total of 620 patients were included in the study and adverse drug events were reported in 179 (29%) of these cases. Doctors reported a statistically significant larger number of serious (26% of all doctor reports; odds ratio (OR) 3.2; confidence interval (CI) 1.2–8.7) and unknown (39%; OR 2.5; CI 1.0–6.0) adverse drug events than patients themselves during the daily ward visit. Doctors also reported more serious and unknown adverse drug events than nurses. Adverse reactions to new drugs were reported during the daily ward visit only (8% of all daily ward visit reports). Conclusion: This study reconfirms that doctors are the main source for reports of serious and unknown adverse drug events in hospitalized patients. However, patients themselves seem to report more adverse reactions to new drugs (during the daily ward visit). By focusing on patients using new drugs, the daily ward visit might become cost-effective. This needs to be explored in future studies. Received: 10 September 1998 / Accepted in revised form: 30 November 1998     

手十二井穴刺络放血法对MCAO模型大鼠大脑皮层c-fos蛋白表达的影响

目的 从脑内c-fos蛋白表达的角度观察井穴放血法对急性缺血性脑损伤的脑保护作用。方法 以凝结法阻断大鼠一侧大脑中动脉造成急性局灶性缺血性脑损伤模型(MCAO)，用免疫组织化学法观察缺血区皮层脑组织c-fos阳性细胞的表达变化及施加手十二井穴放血法后对其的干预治疗作用。结果 急性缺血性脑损伤可快速诱导c-fos蛋白在皮层缺血区脑组织的表达，其表达有随缺血时间延长逐渐增多的趋势，而缺血后即刻施加井穴放血的干预治疗．在1h、3h、6h、24h各缺血时间段均可明显上调缺血区皮层脑组织c-fos蛋白的表达水平。结论 c-fos蛋白表达既与缺血的严重程度有关．也反应神经元的应激反应能力，脑缺血能诱导c-fos蛋白的逐渐表达，提示脑的缺血性损伤可应激性地增强神经细胞对缺血、缺氧的耐受和适应能力。而早期施加井穴刺络放血疗法能进一步增强c-fos蛋白表达，提高神经细胞的应激能力，从而提高缺血区脑组织的抗损伤修复能力，减缓神经细胞凋亡，抵抗缺血性脑损害的进一步发展，产生有效的脑保护作用，表明井穴放血法对中风早期有一定的急救作用。     

灰毡毛忍冬的生药学研究

目的：为灰毡毛忍冬的鉴别，开发利用提供依据。方法：采用来源、性状、显微、理化对其鉴别。结果：首次系统阐明了灰毡毛忍冬的生药学理论。结论：为制订灰毡毛忍冬质量标准提供依据。     

针刺加斜扳法治疗脊神经后支源性下腰痛的临床观察

目的:比较邵氏点针刺加斜扳法、华佗夹脊针刺加斜扳法治疗脊神经后支源性下腰痛的疗效.方法:将70例脊神经后支源性下腰痛患者随机分为2组,分别使用邵氏点针刺加斜扳法、华佗夹脊针刺加斜扳法治疗,每组35例.结果:治疗后邵氏点针刺加斜扳法组疗效较优,且短病程较长病程疗效优.结论:运用神经定位取穴的邵氏点针刺加斜扳法治疗病程较短的脊神经后支源性下腰痛有较好的疗效.     

Dipole-source analysis in a realistic head model in patients with focal epilepsy

PURPOSE: By the use of three different head models in EEG dipole analysis, we tried to model the origin of interictal and ictal epileptic activity as precisely as possible. Further, as a control, a second evaluation was made by an independent group to control for interindividual reliability of the dipole source analysis. With the realistic head model (CURRY) considering cortex, skull, and skin segmentation, the spike source was located. METHODS: In five patients with mesial temporal epileptogenesis, confirmed by successful epilepsy surgery, the spike source was close to the hippocampus, with a mean distance of the dipole source from the hippocampus of 13.6 mm (range, 9-17.2 mm). In one case the ictal EEG also could be analyzed and resulted in a dipole-source localization comparable to the interictal source. RESULTS: In both head models using either pure cortex segmentation only or a concentric three-shell model, the dipole source was systematically dislocated in a more superior position. Data analysis by a second group with independently chosen EEG samples and identical individual head model resulted in deviations of <5.3 mm. Data analysis using independently selected spikes and independently segmented head models resulted in deviations < or =16.7 mm. CONCLUSIONS: In four cases of extratemporal epileptogenesis, the origin of interictal epileptiform discharges was localized to the suspected primary epileptogenic zone.     

Pseudophakic accommodation with translation lenses – dual optic vs mono optic

PURPOSE: To investigate the pseudophakic accommodation effect in dual and mono optic translation accommodative intraocular lenses (AIOL) using linear matrix methods in the paraxial space. METHODS: Dual (anterior optic of power +32 D linked to a compensatory posterior optic of negative power) and mono lens power was determined in the non-accommodated state using linear geometric optics based on the Gullstrand model eye. The position of the AIOL was calculated from a regression formula. Pseudophakic accommodation was assessed with three systems: (1) forward shift of the mono optic lens, (2) anterior translation of the anterior optic in the dual optic lens system with an unchanged position of the posterior minus lens and (3) symmetrical anterior and posterior translation of the anterior and posterior lens. The Gullstrand model eye was modified by changing the axial length (and proportionally changing the phakic anterior chamber depth) to investigate the accommodative effect in myopic and hyperopic eyes. RESULTS: The dual optic lens system (2) yields a nearly constant accommodation amplitude of 2.4-2.5 D mm(-1) movement over the total range of axial lengths. The mono optic lens (1) provides a higher accommodative effect only in extremely short eyes (high refractive power of the lens), whereas for normal eyes (1.4-1.5 D mm(-1) movement) and for long (myopic) eyes the accommodative effect is much less than the dual optic lens. The dual optic lens system under condition (3) yields less accommodation amplitude compared with the dual optic system under condition (2) over the total range of axial length but provides higher accommodation amplitude compared with the mono optic lens system (1) with axial lengths greater than 22.3 mm (lens power 25.5 D). In the accommodated state, with lens translation of 1 mm, the absolute value of the lateral magnification increases with the refractive power of the mono optic lens (1) and decreases in both dual optic lens systems (under conditions 2 and 3). CONCLUSIONS: A mathematical strategy is presented for calculation of the accommodative effect of mono-optic and dual optic AIOL. The dual optic lens yielded a nearly constant accommodation amplitude of about 2.4-2.5 D mm(-1) translation, whereas the mono optic lens yielded an accommodative response of <2 D mm(-1) translation in long myopic or normal eyes. Only in extremely short eyes is the accommodative amplitude of the mono-optic lens higher than the dual optic lens.     

Identification and Determination of Microcystins in Source Water an Waterbloom Sample From Meiliang Bay, Taihu Lake, China

OBJECTIVE: To identify and determine the congener and level of microcystins in the source water of Taihu Lake. METHODS: Improved method of SPE combined with HPLC was employed to detect the concentration and varieties of microcystins in source water and bloom samples collected from Meiliang Bay, Taihu Lake. RESULTS: The contents of two predominant microcystin components, MC-RR, and MC-LR, were relatively high in samples during warm months and correlated with the phase of algae growth. The maximum concentrations of MC-RR and MC-LR in water sample reached 3.09 +/- 0.53 microg/L and 2.39 +/- 0.41 microg/L during the period of water bloom in September 2004, respectively. Even without waterbloom, the concentration of MC-LR in source water sample was still higher than the guideline value. CONCLUSION: The status of microcystin pollution in this region is serious and measures to monitor and control the growth of cyanobacteria are urgently needed.     

乙醇氧化酶两点速率法测定血清微量乙醇

目的：建立一个灵敏、准确、特异、试剂稳定的乙醇氧化酶法用于测定血清微量乙醇浓度。方法：利用乙醇氧化酶与过氧化物酶偶联，通过优化反应体系及自动生化分析仪分析参数，采用两点速率法对乙醇进行分析。结果：乙醇浓度在2000mg／L以下线性良好；批内RSD小于2．81％，批间RSD小于4．51％；平均回收率为100．7％；本法（Y）与气相色谱法（X）比较具有良好的相关性，Y=0．996X＋3．58，r=0．981。胆红素159．1μmol／L、甘油三酯14．31mmol／L、血红蛋白5．8g／L以下对本法测定乙醇结果无干扰。结论：建立的两点速率法测定乙醇灵敏度高、准确度、特异性均较好，特别适合于血清乙醇浓度处于轻度超标的疑似酒后者的标本检测。     

动态针刺穴位对急性脑卒中病人运动功能的影响

目的 观察动态针刺穴位对急性脑卒中病人运动功能障碍的影响。方法 将76例急性脑卒中病人随机分为动态针刺组、传统针灸组和对照组，其中动态针刺组在对照组应用药物治疗的基础上于Brunnstrom Ⅰ期上肢取阴经穴，下肢取阳经穴；Ⅱ期后改用上肢阳经穴为主，下肢以委中、足三里穴为主进行动态针刺。传统针灸组在对照组所用药物的基础上按传统针灸方法进行治疗。比较3组神经功能缺损评分（NFI）、Fugl-Meyer评分（FMA）、Barthel指数（MBI）、临床疗效和康复效率。结果 治疗末期动态针刺组各指标均明显优于传统针灸组和对照组（F=4．372～20．001，q=3．964～5．407，P〈0．01）；传统针灸组在MBI、临床疗效和康复效率方面优于对照组（q=3．461～4．092，P〈0．05、0．01）。结论 动态针刺治疗是肢体康复的有效方法。     

"咳喘宁"贴膏对支气管哮喘模型大鼠血清IL-8及TNF-α的影响

目的:观察穴位贴敷“咳喘宁”贴膏对哮喘模型大鼠血清IL-8及TNF-α的影响。方法:将60只健康W istar大鼠随机分为正常组、模型组、成药组、激素组、高剂量组、低剂量组6组,每组10只。卵白蛋白致敏并诱喘成功后,各治疗组分别予内服桂龙咳喘宁、地塞米松和穴位贴敷“咳喘宁”贴膏进行治疗。治疗6 d后,测定各组大鼠血清IL-8、TNF-α含量并比较其变化。结果:模型组大鼠血清IL-8、TNF-α水平较空白组明显升高(P<0.01);各治疗组IL-8、TNF-α水平较模型组显著降低(P<0.01或P<0.05);成药组和高、低剂量组IL-8、TNF-α水平降低不及激素组(P<0.01或P<0.05);高、低剂量组与成药组比较,均无显著性差异(P>0.05)。结论:穴位贴敷“咳喘宁”贴膏,能降低哮喘大鼠血清IL-8、TNF-α水平,减轻免疫炎性反应,其疗效虽不及内服地塞米松,但等同于内服桂龙咳喘宁,对哮喘有较好的防治作用。