Identification of lead in Asian cosmetics—A test for use by health visitors

Advice given to Asian mothers by the Department of Trade and Industry on testing forlead in traditional cosmetics is proving misleading and is giving rise to concern. No satisfactory test for lead which can be carried out by the mothers currently exists. However, it is recommended that the “water flotation test” is modified by using liquid paraffin and redefining the criteria applied to the results. It is further suggested that testing for lead in these cosmetic materials is performed more definitively by community health visitors who, with minimal instruction, can perform the simple analyses described in detail herein.In conclusion it is recommended that the emphasis should be more firmly based on education of the Asian mother away from use of surma instead of devising methods for testing for lead which may be misleading and, in the long term, are impractical.     

Patient Safety Perceptions of Primary Care Providers after Implementation of an Electronic Medical Record System

BACKGROUND

Increasing the use of electronic medical records (EMR) has been suggested as an important strategy for improving healthcare safety.

OBJECTIVE

To sequentially measure, evaluate, and respond to safety culture and practice safety concerns following EMR implementation.

DESIGN

Safety culture was assessed using a validated tool (Safety Attitudes Questionnaire; SAQ), immediately following EMR implementation (T1) and at 1.5 (T2) and 2.5 (T3) years post-implementation. The SAQ was supplemented with a practice-specific assessment tool to identify safety needs and barriers.

PARTICIPANTS

A large medical group practice with a primary care core of 17–18 practices, staffed by clinicians in family medicine, pediatrics, internal medicine.

INTERVENTIONS

Survey results were used to define and respond to areas of need between assessments with system changes and educational programs.

MAIN MEASURES

Change in safety culture over time; perceived impact of EMR on practice.

KEY RESULTS

Responses were received from 103 of 123 primary care providers in T1 (83.7 % response rate), 122 of 143 in T2 (85.3 %) and 142 of 181 in T3 (78.5 %). Safety culture improved over this period, with statistically significant improvement in all domains except for stress recognition. Time constraints, communications and patient adherence were perceived to be the most important safety issues. The majority of respondents in both T2 (77.9 %) and T3 (85.4 %) surveys agreed that the EMR improved their ability to provide care more safely.

CONCLUSIONS

Implementation of an EMR in a large primary care practice required redesign of many organizational processes, and was associated with improvements in safety culture. Most primary care providers agreed that the EMR allowed them to provide care more safely.     

ACTH和吗啡对创伤痛大鼠海马锥体神经元NMDA受体通道的抑制

目的 探讨创伤痛大鼠海马锥体神经元NMDA受体通道动力学特性的变化ACTH和吗啡的作用。方法 实验以双侧踝关节离断大鼠为创伤痛模型，应用细胞贴附式膜片钳技术。结果 在正常7－10d大鼠急性分离的海马CA1区锥体神经元上，记录到多数膜下的NMDA受体通道有两个电导水平，分别为50pS及38pS,以50pS占多数，且以短开放为主，但也有长开放通道。38pS电导仅有短开放通道。大鼠双侧踝关节完全离断后2h,50pS有38pS短开放通道，50pS长开放通道的开放概率和开放时间均比正常对照组显著增加还出现了38pS长开放通道。在50pS短开放通道的记录中，ACTH^1-24和吗啡可显著抑制创伤大鼠海马CA1区锥体神经元NMDA受体通道的开放概率和开放时间；预中入阿片受体拮抗剂纳络酮能阻断上述的抑制效应。结论 ACTH和吗啡对伤害性信息传递的调制作用可能与其通过阿片受体抑制创伤大鼠海马NMDA受体通道动力学特性的变化有关。     

人胰腺癌裸小鼠模型的建立及其生物学特性的研究

目的 建立荷人胰腺癌裸小鼠模型，研究其生物学特性，观察8988胰腺癌细胞株在移植前后的形态学变化。方法 将人胰腺癌细胞株8988接种于裸鼠腋窝处皮下，每周测量肿瘤大小，第42d处死小鼠。肿瘤组织及相关脏器送病理及电镜检查，放射免疫法检测相关抗原。皮下肿瘤组织细胞及细胞株培养，HE染色。结果 肿瘤生长较快，成功率高，病理及电镜检查符合人胰腺癌细胞特征。肿瘤组织细胞及培养细胞形态学未见显著差异。结论 荷人胰腺癌细胞株8988裸小鼠模型建立方法较简便，细胞形态无明显差异，且保持了人胰腺癌的生物学特性。     

小剂量盐酸普拉克索治疗帕金森病患者吞咽功能障碍的临床研究

目的观察多巴胺受体激动剂盐酸普拉克索治疗帕金森病(PD)患者吞咽功能障碍的疗效和安全性。方法 32例PD伴吞咽功能障碍患者随机分成对照组和普拉克索组。对照组16例继续使用不同剂量的金刚烷胺、多巴丝肼(美多巴);普拉克索组16例在对照组的基础上加用小剂量盐酸普拉克索治疗。两组患者在用药前和用药后第8周均采用藤岛一郎吞咽评分和才藤吞咽障碍分级进行评价。结果普拉克索组PD吞咽功能障碍的藤岛一郎吞咽障碍评分和才藤吞咽障碍分级和对照组比较,差异均有统计学意义(P<0.01)。结论多巴胺受体激动剂盐酸普拉克索治疗帕金森病患者吞咽功能障碍是安全有效的。     

Traditional medicine and lead-containing preparations in Nigeria

Traditional medicine, its preparations and practices, plays a major role in the health care of the community of Nigeria. In many cases the native doctor (“Babalawo”) and the local herbalist (“Eleweomo”) are the only practitioners available for the treatment of illness. Even in the towns where allopathic medicine is available the limited facilities it offers make many patients rely on traditional methods. Little is known of the pharmacological action of these traditional remedies which the native doctor prescribes. Our own studies have concentrated on the metal content of such materials. Here we report on the material known as “tiro” which is used for the treatment of eye infections and disease as well as an “eye cleaner” and cosmetic. On analysis we found that all samples of tiro measured contained lead ranging from 12·8 to 81·1% (w/w), with a mean concentration over all samples determined of 50·1% (w/w). In addition, it was also found that tiro is used by some members of the Nigerian community in Britain and is brought in in decorative containers as a gift. The extent of use in this country still remains to be determined, however. The use of lead-containing preparations^* in traditional practices presents a significant health hazard to a substantial section of the world's population. We suggest urgent steps are required to encourage governments to establish education programmes to eliminate this avoidable source of morbidity among their populations.     

医院药品管理信息系统的研究与实践

药品管理在医院的管理活动中,起着越来越重要的作用。一方面对出入库物流管理,一方面又对出入库信息流建帐管理,工作量大,错漏帐多,效率低。如何以较少资金、较少库存、较快药品周转,实现较高的经济效益、社会效益,是医院目标管理的重要任务。本文简要介绍了医院在药品管理方面,利用计算机网络技术,对药库（房）物流和信息流实施管理的总体规律、详细设计等内容。     

The Electrode‐Tissue Interface: The Revolutionary Role of Steroid‐Elution

The electrode‐tissue interface is that area lying between the cathode of a low‐voltage implantable pacemaker or cardioverter‐defibrillator (ICD) lead and the endocardium or epi‐myocardium of the cardiac chamber being paced. The electrical stimulus that is delivered to this interface is responsible for myocyte depolarization with consequent cardiac contraction. The process by which this occurs is reasonably well understood and any explanation requires a basic understanding of the physics and cellular electrophysiology of pacing. The effective and efficient delivery of electrical energy to the myocardium via the lead is dependent on many factors to be discussed in this review. However, despite numerous evolutionary changes occurring in the cathode's material, design, and surface configuration, it was not until the incorporation of steroid‐elution to the electrode‐tissue interface that reliable and significantly low stimulation threshold cardiac pacing became possible.     

慢性阻塞性睡眠呼吸暂停低通气综合征病情严重程度与心肌损伤及肾功能不全的关系

目的 探讨慢性阻塞性睡眠呼吸暂停低通气综合征的严重程度与心肌损伤及肾功能不全的关系.方法 对108例慢性阻塞性睡眠呼吸暂停低通气综合征患者和50例健康查体者进行呼吸暂停低通气指数、最低血氧饱和度的水平的检测,将患者分成轻、中、重组.计算各组心肌损伤、肾功能不色发生率,检测血清脂蛋白a、心肌肌钙蛋白I及肌酐水平的变化.结果 患者组与正常组比较血清脂蛋白a、心肌肌钙蛋白Ⅰ及肌酐水平明显增高,差异有统计学意义(P＜0.01).患者组组间比较,差异有统计学意义(P＜0.01).患者心肌损伤、肾功能不全的发生率52.78%、25.93%,并且随着病情严重程度分级的升高,心肌损伤、肾功能不全的发生率也在升高.结论 随着病情严重程度分级升高,血清脂蛋白a、心肌肌钙蛋白Ⅰ及肌酐水平在升高,心肌损伤、肾功能不全的患病率也在升高,提示该病患者中心肌损伤、肾功能不全较常见.血清脂蛋白a、心肌肌钙蛋白Ⅰ及肌酐水平可以作为慢性阻塞性睡眠呼吸暂停低通气综合征病情严重程度的评价指标之一.     

数字大平板X射线机DR摄影在胃小溃疡诊断中应用探讨

目的 探讨数字大平板X射线机DR摄影在诊断胃小溃疡应用方面的价值。方法 选取我们所随访搜集的临床胃镜证实的胃小溃疡并做过钡餐检查病例,从2011年8月-2013年8月进行大平板数字透视成像病例55例作为观察组,2013年9月-2015年9月我科开展DR摄影以来的病例82例作为对照组,对比分析结果。结果 大平板数字X射线机DR摄影对于胃小溃疡的诊断率高于数字透视成像(P< 0.05)。结论 数字胃肠大平板DR摄影能够较好的显示胃小溃疡,提高病灶的检查率,减少误诊及漏诊,有助于放射科医师做出正确诊断,为临床治疗提供可靠的依据。