Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

Rapid Increase in Neural Conduction Time in the Adult Human Auditory Brainstem Following Sudden Unilateral Deafness

Individuals with sudden unilateral deafness offer a unique opportunity to study plasticity of the binaural auditory system in adult humans. Stimulation of the intact ear results in increased activity in the auditory cortex. However, there are no reports of changes at sub-cortical levels in humans. Therefore, the aim of the present study was to investigate changes in sub-cortical activity immediately before and after the onset of surgically induced unilateral deafness in adult humans. Click-evoked auditory brainstem responses (ABRs) to stimulation of the healthy ear were recorded from ten adults during the course of translabyrinthine surgery for the removal of a unilateral acoustic neuroma. This surgical technique always results in abrupt deafferentation of the affected ear. The results revealed a rapid (within minutes) reduction in latency of wave V (mean pre = 6.55 ms; mean post = 6.15 ms; p < 0.001). A latency reduction was also observed for wave III (mean pre = 4.40 ms; mean post = 4.13 ms; p < 0.001). These reductions in response latency are consistent with functional changes including disinhibition or/and more rapid intra-cellular signalling affecting binaurally sensitive neurons in the central auditory system. The results are highly relevant for improved understanding of putative physiological mechanisms underlying perceptual disorders such as tinnitus and hyperacusis.     

Investigating the association between eye colour and the Neurological Pupil index

IntroductionBrown or dark brown eyes make it difficult to distinguish the contrast between a black pupil and the surrounding iris, which may result in clinical assessment errors. The pupillometer can be used to derive an indexed value, the Neurological Pupil index™ (NPi) for pupillary light reflex. However, there are limited data associating the NPi and iris colour. We examine the NPi and eye colour association.MethodsData were pooled from the Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care (END-PANIC) Registry. The analysis includes 14,168 observations collected from 865 patients with neurological conditions who were admitted to the intensive care unit. Summary statistics and statistical models were developed to examine the association using Statistical Analysis Software (SAS) summary procedure.ResultsThe mean age of the cohort was 56 years (standard deviation = 17). Eye colour included dark brown (n = 339), blue (n = 234), brown (n = 173), green (n = 82), and other (n = 37). There was significant differences (p < 0.0001) between mean NPi values by eye colour [blue = 4.08 (0.92), brown = 3.34 (1.45), dark = 3.71 (1.33), green = 4.08 (0.67), other = 3.76 (1.25)]. However, a further random-effects mixed model after controlling for confounding variables revealed no significant difference in NPi values among different eye colour groups.ConclusionsThe pupillary light reflex, when assessed using the pupillometer, is not dependent on the eye colour. Practitioners are not required to consider eye colour as a confounder when they perform pupillary assessment for examining patients with neurological conditions.     

大面积堆场逐级增高下软土地基变形特性

通过历时2 a的现场监测,揭示了大面积堆场逐级增高情况下软土地基变形特性的规律,总结了固结沉降的规律,为软土地基的固结沉降分析计算提供依据.     

充气温控毯用于神经外科手术患者的控温效果

目的评价充气温控毯用于神经外科手术患者的控温效果。方法40例择期行平卧位脑肿瘤切除术患者,年龄16—65岁,体重41-72 kg,ASAⅠ-Ⅲ级,随机分为2组(n=20):A组,术中充气温控毯24℃风档进行降温,肿瘤切除完毕前30 min进行复温;B组,术中充气温控毯维持中心温度正常(35．2—36．60℃)。均采用气管内静吸复合麻醉,静脉注射异丙酚1．5～2 mg／kg、芬太尼4-6μg／kg、维库溴铵0．1～0．2 mg／kg诱导,吸入0．6％-1．2％异氟醚维持;吸入氧浓度40％;异丙酚1．5～2 mg·kg-1·h-1持续输注;维库溴铵1～2 mg间断静脉注射。每5分钟记录1次中心温度(鼻咽温),观察围术期不良反应及并发症。结果A组2例患者因手术时间超过24 h剔除,共38例进行统计。A组患者降温速率(1．11±0．05)℃／h,复温速率(0．74±0．09)℃／h。A组患者89％(16/18)在硬脑膜打开前达到目标温度34℃,平台期平均中心温度(34．3±0．5)℃,距34℃最大升幅0．52℃,最大降幅为0．23℃。A组患者67％(12／18)手术结束时中心温度恢复正常。返回ICU后A组患者中心温度(返回ICU时实测温度的均值)(35．8±0．6)℃低于B组(36．6±0．4)℃(P<0．05)。A组患者4例术后出现寒颤、3例发热、1例死亡。结论神经外科手术中应用充气温控毯可较理想地降低体温,相对于降温效率其复温效率偏低。     

Acoustic rhinometry in pre-school children

Acoustic rhinometry was performed in 35 normal nose-breathing children between 3 and 6 years. The average cross-sectional areas at the nasal valve, at the anterior end of the turbinates, and in the nasopharynx were 0.34±0.06 cm², 0.35±0.08 cm² and 1.37±0.48 cm² respectively. The average minimal cross-sectional area was 0.29±0.06 cm². The minimal cross-sectional area was located at the nasal valve in 14 and at the anterior end of nasal tubinates in 21 of the 35 children. As would be expected, the cross-sectional areas at different sites of the nasal cavity increased with increasing age of the children. But, whereas the minimal cross-sectional area increased by 0.024 cm² per year, the nasopharyngeal cross-sectional area increased by 0.20 cm² per year. No significant differences were found between boys and girls. Measurements of the posterior nasal and nasopharyngeal cross-sectional areas were unreliable, whenever the minimal cross-sectional area was less than 0.2 cm². Furthermore, assessment of the nasopharynx may be difficult because of involuntary movements of the soft palate.     

The value of the acoustic analysis of pathological infant cry and breathing noise in everyday practice

During a period of twenty years [1969-1988] the author has observed 614 cases of congenital malformations and noninflammatory diseases of the larynx in infants and young children, Budapest. He summarizes the most characteristic symptoms of laryngeal pathology in infants, and discusses the diagnostic possibilities. Among the latter, spectrographic analyses complemented by auditory evaluation of pathological cry and different breathing noises play an important role. Based on his investigation author differentiates 20 kinds of pathological crying sounds and 4 basic forms of stridor. He describes the acoustic attributes of different pathological sound phenomena and summarizes characteristic voice changes.     

37. Perioperatives Risiko — Kontroversen zur Pathogenese -Integration der Standpunkte

Zusammenfassung 1. Das perioperative Risiko muss als Gesamtrisiko von Anaesthesisten und Chirurgen gemeinsam erfasst werden. 2. Gemeinsame Risikoklassen sind dringend erforderlich. 3. Art und Umfang von Screeninguntersuchungen bedürfen einheitlicher Festlegungen. 4. Jedes Risiko muss durch geeignete Vorbehandlungsmassnahmen gemindert werden. 5. Intraoperatives Vorgehen sowie intra- und postoperatives Monitoring sollten gemeinsam diskutiert werden. 6. Die postoperative Phase sollte Gegenstand prospektiver Untersuchungen werden.